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General NPI Number Information
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NPI Number | 1811987696
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Entity Type | Organization
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Legal Business Name | NICHOLS CLINIC LLC
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Dates
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Enumeration Date | 10/24/2005
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Last Update Date | 12/18/2024
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Provider Practice Location Address
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Address Line | 220 ELKHORN ST
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City | ELKHORN CITY
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State | KY
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Zip | 41522
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Country | US
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Telephone | 606-754-5076
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Fax | 606-754-5557
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Provider Business Mailing Address
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Address Line | 1002 S BROADWAY ST STE 7
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City | GEORGETOWN
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State | KY
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Zip | 40324-1463
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Country | US
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Telephone | 606-754-5076
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Fax | 606-754-5557
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Authorized Official
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Title or Position | PRESIDENT
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Name | PETER SAAD
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Credential |
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Telephone | 318-259-7334
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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 |
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License Number State |
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