Healthcare Provider Details

I. General information

NPI: 1508504150
Provider Name (Legal Business Name): EMILY NICHOLSON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2022
Last Update Date: 05/24/2022
Certification Date: 05/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 W 10TH AVE
COLUMBUS OH
43210-1240
US

IV. Provider business mailing address

844 S LONGBRANCH CIR
MAIZE KS
67101-7007
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-8470
  • Fax: 614-293-3165
Mailing address:
  • Phone: 307-287-9672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2021030444
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03441841
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1-103866
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: