Healthcare Provider Details

I. General information

NPI: 1407779861
Provider Name (Legal Business Name): DR. NIKIDA METELLUS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NIKIDA VAUGHN PHARMD.

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3121 DIABLO AVE
HAYWARD CA
94545-2701
US

IV. Provider business mailing address

5087 EDGEWATER DR UNIT 607717
ORLANDO FL
32860-2535
US

V. Phone/Fax

Practice location:
  • Phone: 650-353-5495
  • Fax:
Mailing address:
  • Phone: 407-906-0912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS43831
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: