Healthcare Provider Details

I. General information

NPI: 1770249831
Provider Name (Legal Business Name): NICHOLAS SYKES PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2021
Last Update Date: 08/14/2023
Certification Date: 08/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 KEN PRATT BLVD
LONGMONT CO
80501-6419
US

IV. Provider business mailing address

1710 SPRINGWATER AVE UNIT A
WENATCHEE WA
98801-1472
US

V. Phone/Fax

Practice location:
  • Phone: 303-827-3480
  • Fax: 303-827-3540
Mailing address:
  • Phone: 843-603-2207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number23422
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: