Provider Demographics
NPI:1093081572
Name:NICHOLS, ANN (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:NICHOLS
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 1:6271 CAROLINA COMMONS DR
Mailing Address - Street 2:
Mailing Address - City:INDIAN LAND
Mailing Address - State:SC
Mailing Address - Zip Code:29707-5980
Mailing Address - Country:US
Mailing Address - Phone:803-802-5400
Mailing Address - Fax:
Practice Address - Street 1:6271 CAROLINA COMMONS DR
Practice Address - Street 2:
Practice Address - City:INDIAN LAND
Practice Address - State:SC
Practice Address - Zip Code:29707-5980
Practice Address - Country:US
Practice Address - Phone:803-802-5400
Practice Address - Fax:803-548-9355
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13486183500000X
NC22131183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist