Healthcare Provider Details

I. General information

NPI: 1063235760
Provider Name (Legal Business Name): NICKOLAS T OSKING PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2024
Last Update Date: 11/02/2024
Certification Date: 11/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 JEFFERSON ST NE STE D
ALBUQUERQUE NM
87113-1884
US

IV. Provider business mailing address

102 MULLEN RD NE APT 4
ALBUQUERQUE NM
87107-5919
US

V. Phone/Fax

Practice location:
  • Phone: 505-221-9957
  • Fax:
Mailing address:
  • Phone: 505-221-9957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00010103
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: