Healthcare Provider Details

I. General information

NPI: 1295289908
Provider Name (Legal Business Name): NIKKI NORTHUP PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2016
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

965 POPLAR ST
NELSONVILLE OH
45764-1442
US

IV. Provider business mailing address

965 POPLAR ST
NELSONVILLE OH
45764-1442
US

V. Phone/Fax

Practice location:
  • Phone: 740-753-1984
  • Fax: 740-753-3188
Mailing address:
  • Phone: 740-753-1984
  • Fax: 740-753-3188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRP0006836
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03326650
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: