Provider Demographics
NPI:1093337693
Name:RICKOFF, NICHOLAS
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:RICKOFF
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 1:204 BELKNAP ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-2964
Mailing Address - Country:US
Mailing Address - Phone:507-458-4447
Mailing Address - Fax:
Practice Address - Street 1:204 BELKNAP ST STE 100
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-2964
Practice Address - Country:US
Practice Address - Phone:715-817-7224
Practice Address - Fax:715-817-7193
Is Sole Proprietor?:No
Enumeration Date:2020-05-18
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN124365183500000X
MI5302415026183500000X
WI20239-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20239-40OtherWISCONSIN
MN124365OtherMN BOARD OF PHARMACY
MI5302415026OtherMI