MEDICARE: RUSSELL NICHOLS PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	26021396A	IN

General Provider Information

NPI Number	:	1326640533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUSSELL NICHOLS PHARMD

Provider Business Mailing Address
First Line	:	3589 CALLOWELL CT
Second Line	:
City	:	CARMEL
State	:	IN
Zip	:	46032-8215
Country	:	US
Telephone Number	:	317-732-5241
Fax Number	:

Provider Business Practice Location Address
First Line	:	893 S DELAWARE ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46225-1782
Country	:	US
Telephone Number	:	317-276-9699
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/12/2020
Last Update Date	:	11/12/2020

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