Provider Demographics
NPI:1811388705
Name:NAKKEN, GARY
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:NAKKEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:863 N 980 W
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-7710
Mailing Address - Country:US
Mailing Address - Phone:801-607-2138
Mailing Address - Fax:801-225-2388
Practice Address - Street 1:863 N 980 W
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-7710
Practice Address - Country:US
Practice Address - Phone:801-607-2138
Practice Address - Fax:801-225-2388
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-12
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7214363-1703183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No183500000XPharmacy Service ProvidersPharmacist