Healthcare Provider Details

I. General information

NPI: 1336469568
Provider Name (Legal Business Name): THOMAS JOHN NICHOLSON B.S., RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 06/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2381 PLYMOUTH ROAD
ANN ARBOR MI
48105
US

IV. Provider business mailing address

924 WOODRIDGE HILLS DR
BRIGHTON MI
48116-2404
US

V. Phone/Fax

Practice location:
  • Phone: 734-761-6404
  • Fax:
Mailing address:
  • Phone: 810-227-8166
  • Fax: 810-227-8166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302018224
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: