MEDICARE: DR. AMY SUZANNE NICHOLAS PHARMD, CDE

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	1835P1200X	Pharmacotherapy Pharmacist	011436	KY

General Provider Information

NPI Number	:	1699768515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMY SUZANNE NICHOLAS PHARMD, CDE

Provider Business Mailing Address
First Line	:	108 AUTUMN HILLS WAY
Second Line	:
City	:	NICHOLASVILLE
State	:	KY
Zip	:	40356-8223
Country	:	US
Telephone Number	:	859-881-0162
Fax Number	:

Provider Business Practice Location Address
First Line	:	725 ROSE STREET
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40536-0001
Country	:	US
Telephone Number	:	859-323-8987
Fax Number	:

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

Provider Enumeration Date	:	08/25/2005
Last Update Date	:	07/08/2007

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