Healthcare Provider Details

I. General information

NPI: 1417379595
Provider Name (Legal Business Name): NICKAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2014
Last Update Date: 06/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 W OTTAWA ST
RICHWOOD OH
43344-1139
US

IV. Provider business mailing address

24 W OTTAWA ST
RICHWOOD OH
43344-1139
US

V. Phone/Fax

Practice location:
  • Phone: 740-943-2233
  • Fax: 740-943-2323
Mailing address:
  • Phone: 740-943-2233
  • Fax: 740-943-2323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberRTP022374450
License Number StateOH

VIII. Authorized Official

Name: LISA SHEEHAN
Title or Position: OWNER
Credential:
Phone: 740-943-2233