Provider Demographics
NPI:1003405556
Name:BLAND, NICHOLAS OSCAR (PHARMD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:OSCAR
Last Name:BLAND
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 W POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-3033
Mailing Address - Country:US
Mailing Address - Phone:770-227-7772
Mailing Address - Fax:
Practice Address - Street 1:222 W POPLAR ST
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-3033
Practice Address - Country:US
Practice Address - Phone:770-227-7772
Practice Address - Fax:770-227-7313
Is Sole Proprietor?:No
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH023704183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist