Active NPI
Nathan Bullock, PHARMD
- Pharmacist
- Provo, UT
National Provider Identifier
1447566476
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 6023383-1701
- Practice address
- 1324 N State St
Provo, UT 84604-2419 - Phone
- (801) 374-2015
- Fax
- (801) 374-9954
- NPI assigned
- Aug 27, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 6023383-1701 | UT | Primary |
Addresses
Primary practice location
1324 N State St
Provo, UT 84604-2419
Mailing address
743 W Meadow Side Dr
Saratoga Springs, UT 84045-5316
Phone (801) 494-5092
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6023383-1701 | UT | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1282867200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1282867200000",
"number": "1447566476",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "743 W MEADOW SIDE DR",
"city": "SARATOGA SPRINGS",
"state": "UT",
"postal_code": "840455316",
"telephone_number": "801-494-5092"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1324 N STATE ST",
"city": "PROVO",
"state": "UT",
"postal_code": "846042419",
"telephone_number": "801-374-2015",
"fax_number": "801-374-9954"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BULLOCK",
"first_name": "NATHAN",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-08-27",
"last_updated": "2010-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "UT",
"license": "6023383-1701",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Provo, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.