Healthcare Provider Details

I. General information

NPI: 1437164027
Provider Name (Legal Business Name): NICHOLS PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 01/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 E FOURTH ST
DEQUINCY LA
70633-3709
US

IV. Provider business mailing address

PO BOX 355
DEQUINCY LA
70633-0355
US

V. Phone/Fax

Practice location:
  • Phone: 337-786-4004
  • Fax: 337-786-4005
Mailing address:
  • Phone: 337-786-4000
  • Fax: 337-786-4005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY000818IR
License Number StateLA

VIII. Authorized Official

Name: COLLEEN PINDER
Title or Position: PRES CHIEF PHARM
Credential:
Phone: 337-786-4004