Provider Demographics
NPI:1063830941
Name:CHOI, NICHOLAS
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:CHOI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9240 GARDEN GROVE BLVD
Mailing Address - Street 2:SUITE 20
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-1400
Mailing Address - Country:US
Mailing Address - Phone:714-638-8230
Mailing Address - Fax:714-638-0988
Practice Address - Street 1:9240 GARDEN GROVE BLVD
Practice Address - Street 2:SUITE 20
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844-1400
Practice Address - Country:US
Practice Address - Phone:714-638-8230
Practice Address - Fax:714-638-0988
Is Sole Proprietor?:No
Enumeration Date:2014-03-28
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 66215183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist