Healthcare Provider Details

I. General information

NPI: 1346227535
Provider Name (Legal Business Name): STEVEN L NICHOLSON RPH, PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 01/28/2020
Certification Date: 01/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5705 62ND AVE SW
GREAT FALLS MT
59404-5244
US

IV. Provider business mailing address

5705 62ND AVE SW
GREAT FALLS MT
59404-5244
US

V. Phone/Fax

Practice location:
  • Phone: 406-771-7280
  • Fax:
Mailing address:
  • Phone: 406-771-7280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3826
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number3826
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: