Individual
NINA IVANOVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6545 N LANDMARK DR, PARK CITY, UT 84098-5990
(435) 647-9040
(435) 647-9042
Mailing address
6545 N LANDMARK DR, PARK CITY, UT 84098-5990
(435) 647-9040
(435) 647-9042
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
292261
UT
Other
Enumeration date
11/13/2020
Last updated
11/13/2020
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