MEDICARE: NICHOLAS RIDENOUR PHARMD

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	03444274	OH

General Provider Information

NPI Number	:	1225874944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS RIDENOUR PHARMD

Provider Business Mailing Address
First Line	:	8217 LILLY LN
Second Line	:
City	:	CONCORD TOWNSHIP
State	:	OH
Zip	:	44077-8580
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1505 NORTH MAIN STREET
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720
Country	:	US
Telephone Number	:	234-236-2610
Fax Number	:	234-236-2625

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

Provider Enumeration Date	:	07/02/2024
Last Update Date	:	07/02/2024

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