MEDICARE: WOODEN NICHOLS INC

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	024692	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881747368
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOODEN NICHOLS INC

Provider Business Mailing Address
First Line	:	5 MAPLE RD
Second Line	:
City	:	VOORHEESVILLE
State	:	NY
Zip	:	12186-9413
Country	:	US
Telephone Number	:	518-765-2629
Fax Number	:	518-765-5043

Provider Business Practice Location Address
First Line	:	5 MAPLE RD
Second Line	:
City	:	VOORHEESVILLE
State	:	NY
Zip	:	12186
Country	:	US
Telephone Number	:	518-765-2629
Fax Number	:	518-765-5043

Authorized Official
Title or Position	:	OWNER
Name	:	MS. ELAINE NICHOLS
Credential	:
Telephone Number	:	518-765-2629

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	08/22/2020

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Directions to “WOODEN NICHOLS INC ” Practice Location

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