MEDICARE: MR. BRUCE SEELEY NICHOLS RPH

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	042810	MO

General Provider Information

NPI Number	:	1528019601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRUCE SEELEY NICHOLS RPH

Provider Business Mailing Address
First Line	:	905 HOLIDAY AVE
Second Line	:
City	:	HAZELWOOD
State	:	MO
Zip	:	63042-3325
Country	:	US
Telephone Number	:	314-895-3657
Fax Number	:

Provider Business Practice Location Address
First Line	:	3023 N BALLAS RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63131-2330
Country	:	US
Telephone Number	:	314-996-7501
Fax Number	:

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

Provider Enumeration Date	:	05/13/2006
Last Update Date	:	07/08/2007

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