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General NPI Number Information
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NPI Number | 1811927411
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Entity Type | Individual
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Provider Name | SUSAN C NICHOLS RPH, PHARMD
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Gender | Female
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 400 VETERANS AVE 119
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City | BILOXI
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State | MS
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Zip | 39531-2410
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Country | US
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Telephone | 228-523-5236
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Fax |
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Provider Business Mailing Address
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Address Line | 130B CRITZ ST N APT B
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City | WIGGINS
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State | MS
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Zip | 39577-3216
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Country | US
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Telephone | 601-928-7142
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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 | 09106
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 14797
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License Number State | MS
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