Provider Demographics
NPI:1114251204
Name:NICHOLS, JAMES TAYLOR (RPH)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:TAYLOR
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 402 BOX 515
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09180-0515
Mailing Address - Country:US
Mailing Address - Phone:01522-409-1446
Mailing Address - Fax:
Practice Address - Street 1:CMR 402 BOX 515
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09180-0515
Practice Address - Country:US
Practice Address - Phone:01522-409-1446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36308183500000X
OK12111183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist