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General NPI Number Information
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NPI Number | 1336469568
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Entity Type | Individual
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Provider Name | THOMAS JOHN NICHOLSON B.S., RPH
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Gender | Male
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Dates
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Enumeration Date | 06/10/2010
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Last Update Date | 06/10/2010
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Provider Practice Location Address
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Address Line | 2381 PLYMOUTH ROAD
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City | ANN ARBOR
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State | MI
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Zip | 48105
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Country | US
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Telephone | 734-761-6404
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Fax |
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Provider Business Mailing Address
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Address Line | 924 WOODRIDGE HILLS DR
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City | BRIGHTON
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State | MI
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Zip | 48116-2404
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Country | US
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Telephone | 810-227-8166
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Fax | 810-227-8166
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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 | 5302018224
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License Number State | MI
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