Healthcare Provider Details

I. General information

NPI: 1528994613
Provider Name (Legal Business Name): LISA N NICHOLSON RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

541 HISTORIC OLD HIGHWAY 441
CLARKESVILLE GA
30523-3983
US

IV. Provider business mailing address

PO BOX 1835
CLARKESVILLE GA
30523-0031
US

V. Phone/Fax

Practice location:
  • Phone: 706-754-3113
  • Fax:
Mailing address:
  • Phone: 706-754-3113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH014865
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: