Provider Demographics
NPI:1083074827
Name:NICHOLS, MILTON
Entity Type:Individual
Prefix:
First Name:MILTON
Middle Name:
Last Name:NICHOLS
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 1:12138 CENTRAL AVE
Mailing Address - Street 2:483
Mailing Address - City:MITCHELLVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-1910
Mailing Address - Country:US
Mailing Address - Phone:240-354-6995
Mailing Address - Fax:301-949-4926
Practice Address - Street 1:12138 CENTRAL AVE
Practice Address - Street 2:483
Practice Address - City:MITCHELLVILLE
Practice Address - State:MD
Practice Address - Zip Code:20721-1910
Practice Address - Country:US
Practice Address - Phone:240-354-6995
Practice Address - Fax:301-949-4926
Is Sole Proprietor?:No
Enumeration Date:2016-03-04
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13081183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist