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Individual

NICHOLAS WEAVER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PHARMD.

Contact information

Practice address
100 N MARIO CAPECCHI DR, SALT LAKE CITY, UT 84113-1103
(801) 662-2666
Mailing address
5299 S CHALKMARK CIR, TAYLORSVILLE, UT 84129-1570
(801) 574-0050

Taxonomy

Speciality
Code
Description
License number
State
1835P0018X
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Primary
6099454-1701
UT
1835P0200X
Pediatric Pharmacist
6099454-1701
UT

Other

Enumeration date
01/11/2019
Last updated
01/11/2019
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