MEDICARE: JESSICA NICHOLS MAIN 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	81345	CA

General Provider Information

NPI Number	:	1417686189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA NICHOLS MAIN PHARMD

Provider Business Mailing Address
First Line	:	2631 E ECLIPSE AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93720-4625
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	785 N MEDICAL CENTER DR W
Second Line	:
City	:	CLOVIS
State	:	CA
Zip	:	93611-6878
Country	:	US
Telephone Number	:	559-387-1862
Fax Number	:

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

Provider Enumeration Date	:	06/08/2022
Last Update Date	:	06/08/2022

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