Healthcare Provider Details

I. General information

NPI: 1104718188
Provider Name (Legal Business Name): NICHOLAS RAWE RPH, PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2025
Last Update Date: 07/16/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 BURNET AVE
CINCINNATI OH
45229-3019
US

IV. Provider business mailing address

94 THREE MILE RD
WILDER KY
41076-9705
US

V. Phone/Fax

Practice location:
  • Phone: 513-585-9700
  • Fax: 513-585-9711
Mailing address:
  • Phone: 859-496-7941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number012357
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03442521
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: