Provider Demographics
NPI:1003159260
Name:NICKENS, REBECCA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:
Last Name:NICKENS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6922 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-9726
Mailing Address - Country:US
Mailing Address - Phone:970-352-4150
Mailing Address - Fax:970-352-4152
Practice Address - Street 1:6922 W 10TH ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-9726
Practice Address - Country:US
Practice Address - Phone:970-392-4150
Practice Address - Fax:970-392-4152
Is Sole Proprietor?:No
Enumeration Date:2013-04-05
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO18688183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist