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General NPI Number Information
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NPI Number | 1669535274
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Entity Type | Organization
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Legal Business Name | DOUGLAS E NYKANEN
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 05/31/2011
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Provider Practice Location Address
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Address Line | 120 N CASCADE ST
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City | OSCEOLA
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State | WI
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Zip | 54020-7000
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Country | US
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Telephone | 715-294-2110
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Fax | 715-294-1617
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Provider Business Mailing Address
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Address Line | PO BOX 279
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City | OSCEOLA
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State | WI
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Zip | 54020-0279
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Country | US
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Telephone | 715-294-2110
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Fax | 715-294-1617
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Authorized Official
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Title or Position | OWNER AND PHARM
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Name | DOUGLAS NYKANEN
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Credential | RPH
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Telephone | 715-294-2110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 6601-42
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License Number State | WI
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