Provider Demographics
NPI:1609609817
Name:COLSON, NICHOLAS ALAN
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:ALAN
Last Name:COLSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16137 S TRUSS DR
Mailing Address - Street 2:
Mailing Address - City:BLUFFDALE
Mailing Address - State:UT
Mailing Address - Zip Code:84065-1868
Mailing Address - Country:US
Mailing Address - Phone:480-710-4561
Mailing Address - Fax:
Practice Address - Street 1:7777 S REDWOOD RD
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84084-5518
Practice Address - Country:US
Practice Address - Phone:801-255-9077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14141298-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist