Healthcare Provider Details

I. General information

NPI: 1457769184
Provider Name (Legal Business Name): NICHOLE ALTHOUSE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2014
Last Update Date: 07/12/2026
Certification Date: 07/12/2026
Deactivation Date: 06/11/2015
Reactivation Date: 06/21/2018

III. Provider practice location address

43300 SOUTHERN WALK PLZ
BROADLANDS VA
20148-4463
US

IV. Provider business mailing address

7250 CARSON BLVD
LONG BEACH CA
90808-2358
US

V. Phone/Fax

Practice location:
  • Phone: 703-723-0981
  • Fax: 703-723-0981
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number70550
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number0202212881
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: