Provider Demographics
NPI:1932963212
Name:ANDERSON, NATHAN KRISTOPHER (PHARMD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:KRISTOPHER
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6013 HULL CT
Mailing Address - Street 2:
Mailing Address - City:STANSBURY PARK
Mailing Address - State:UT
Mailing Address - Zip Code:84074-9097
Mailing Address - Country:US
Mailing Address - Phone:801-971-4874
Mailing Address - Fax:
Practice Address - Street 1:6013 HULL CT
Practice Address - Street 2:
Practice Address - City:STANSBURY PARK
Practice Address - State:UT
Practice Address - Zip Code:84074-9097
Practice Address - Country:US
Practice Address - Phone:801-971-4874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9036240-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist