Individual
NATHAN BULLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
1324 N STATE ST, PROVO, UT 84604-2419
(801) 374-2015
(801) 374-9954
Mailing address
743 W MEADOW SIDE DR, SARATOGA SPRINGS, UT 84045-5316
(801) 494-5092
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
6023383-1701
UT
Other
Enumeration date
08/27/2010
Last updated
08/27/2010
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