Healthcare Provider Details

I. General information

NPI: 1851010896
Provider Name (Legal Business Name): NICHOLAS CLARK HOBSON PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 TATES CREEK CENTRE DR
LEXINGTON KY
40517-3066
US

IV. Provider business mailing address

9224 E BLUE RIVER RD
PEKIN IN
47165-8385
US

V. Phone/Fax

Practice location:
  • Phone: 859-272-2575
  • Fax:
Mailing address:
  • Phone: 812-620-7878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number022950
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: