Healthcare Provider Details

I. General information

NPI: 1295644037
Provider Name (Legal Business Name): NICHOLAS GEORGE DORER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10500 MONTGOMERY RD
MONTGOMERY OH
45242-4402
US

IV. Provider business mailing address

4368 CENTENNIAL DR APT 124
CINCINNATI OH
45227-2598
US

V. Phone/Fax

Practice location:
  • Phone: 513-865-1111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03446726
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: