MEDICARE: NICHOLAS FETTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	122035	MN
2	183500000X	Pharmacist	60797	TX
3	183500000X	Pharmacist	17399-40	WI

General Provider Information

NPI Number	:	1053731521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS FETTER

Provider Business Mailing Address
First Line	:	299 MONROE AVE APT 2411
Second Line	:
City	:	ROANOKE
State	:	TX
Zip	:	76262-6745
Country	:	US
Telephone Number	:	218-310-8652
Fax Number	:

Provider Business Practice Location Address
First Line	:	976 KELLER PKWY
Second Line	:
City	:	KELLER
State	:	TX
Zip	:	76248-3608
Country	:	US
Telephone Number	:	817-431-5178
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2014
Last Update Date	:	05/19/2026

Similar Medicare Providers

1245972371 — CRISTINA BRYANT PHARMD
Practice Location Address:

976 KELLER PKWY
KELLER, TX
76248-3608

Practice Phone: 817-431-5178
Practice Fax:

1023649704 — ASHLEY MAI PHAM R.PH
Practice Location Address:

976 KELLER PKWY
KELLER, TX
76248-3608

Practice Phone: 817-431-5178
Practice Fax:

1710585237 — JUDITH VIRGINIA FLESHER
Practice Location Address:

976 KELLER PKWY
KELLER, TX
76248-3608

Practice Phone: 817-431-5179
Practice Fax:

1033718002 — TITO COOMBER
Practice Location Address:

976 KELLER PKWY
KELLER, TX
76248-3608

Practice Phone: 817-431-5178
Practice Fax:

1922939966 — BRITNEY ROMAN ONEILL
Practice Location Address:

1727 KELLER PKWY STE 19
KELLER, TX
76248-3705

Practice Phone: 817-500-5895
Practice Fax:

1639008477 — JESSICA STILL
Practice Location Address:

8821 DAVIS BLVD STE 100
KELLER, TX
76248-0329

Practice Phone: 800-345-0448
Practice Fax:

Directions to “ NICHOLAS FETTER ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.