Healthcare Provider Details

I. General information

NPI: 1578785051
Provider Name (Legal Business Name): MS. MURIEL CAROL NICHOLAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8733 BEVERLY BLVD MIDWEST PHARMACY
LOS ANGELES CA
90048
US

IV. Provider business mailing address

8733 BEVERLY BLVD MIDWEST PHARMACY
LOS ANGELES CA
90048
US

V. Phone/Fax

Practice location:
  • Phone: 310-657-1635
  • Fax: 310-657-5455
Mailing address:
  • Phone: 310-657-1635
  • Fax: 310-657-5455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberTCH 29647
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: