MEDICARE: MRS. PAMELA ANN NICHOLS PHARMACIST

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	03222814	OH

General Provider Information

NPI Number	:	1346912953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PAMELA ANN NICHOLS PHARMACIST

Provider Business Mailing Address
First Line	:	1049 STARLIGHT DR
Second Line	:
City	:	SEVEN HILLS
State	:	OH
Zip	:	44131-4049
Country	:	US
Telephone Number	:	440-263-0789
Fax Number	:

Provider Business Practice Location Address
First Line	:	30275 DETROIT RD
Second Line	:
City	:	WESTLAKE
State	:	OH
Zip	:	44145-1948
Country	:	US
Telephone Number	:	440-871-5710
Fax Number	:

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

Provider Enumeration Date	:	10/01/2021
Last Update Date	:	10/01/2021

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