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General NPI Number Information
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NPI Number | 1073523932
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Entity Type | Individual
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Provider Name | DAVID EUGENE NICKLAS DPH
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Gender | Male
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1442 N HARRISON ST
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City | SHAWNEE
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State | OK
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Zip | 74801-5208
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Country | US
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Telephone | 405-273-9906
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Fax | 405-273-4329
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Provider Business Mailing Address
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Address Line | 1807 HENSON CT
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City | SHAWNEE
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State | OK
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Zip | 74804-4240
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Country | US
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Telephone | 405-275-6169
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 9416
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License Number State | OK
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