Provider Demographics
NPI:1871632521
Name:NAKAMURA, CALVIN RICHARD (RPH)
Entity Type:Individual
Prefix:MR
First Name:CALVIN
Middle Name:RICHARD
Last Name:NAKAMURA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4854 CROSS CREEK LN
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-4982
Mailing Address - Country:US
Mailing Address - Phone:801-288-9391
Mailing Address - Fax:801-485-2271
Practice Address - Street 1:2040 S 2300 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-3220
Practice Address - Country:US
Practice Address - Phone:801-487-1018
Practice Address - Fax:801-485-2271
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2254191701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT4606515OtherNABP