Healthcare Provider Details

I. General information

NPI: 1164449070
Provider Name (Legal Business Name): NICHOLS DRUG STORES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 02/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 S MAIN ST
SCOTTVILLE MI
49454-1221
US

IV. Provider business mailing address

112 S MAIN ST
SCOTTVILLE MI
49454-1221
US

V. Phone/Fax

Practice location:
  • Phone: 231-757-3749
  • Fax: 231-757-2396
Mailing address:
  • Phone: 231-757-3749
  • Fax: 231-757-2396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301001614
License Number StateMI

VIII. Authorized Official

Name: MR. JAMES LEO NICHOLS
Title or Position: OWNER
Credential:
Phone: 231-757-3749