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General NPI Number Information
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NPI Number | 1740354042
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Entity Type | Organization
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Legal Business Name | NICKAL INC
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 01/24/2014
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Provider Practice Location Address
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Address Line | 171 S. MAIN ST.
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City | PROSPECT
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State | OH
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Zip | 43342
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Country | US
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Telephone | 740-494-2663
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Fax | 740-494-4087
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Provider Business Mailing Address
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Address Line | 171 S MAIN ST PO BOX 68
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City | PROSPECT
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State | OH
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Zip | 43342-9569
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Country | US
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Telephone | 740-494-2663
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Fax | 740-494-4087
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Authorized Official
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Title or Position | OWNER
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Name | MR. TIMMY JON SHEEHAN
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Credential | RPH
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Telephone | 740-494-2663
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 02069125004609
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License Number State | OH
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