Provider Demographics
NPI:1154661684
Name:NICHOLS, COREY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:COREY
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3633 GRAY AVE
Mailing Address - Street 2:
Mailing Address - City:ADAMSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35005-2238
Mailing Address - Country:US
Mailing Address - Phone:205-674-1400
Mailing Address - Fax:205-674-1525
Practice Address - Street 1:3633 GRAY AVE
Practice Address - Street 2:
Practice Address - City:ADAMSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35005-2238
Practice Address - Country:US
Practice Address - Phone:205-674-1400
Practice Address - Fax:205-674-1525
Is Sole Proprietor?:No
Enumeration Date:2013-02-20
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15829183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist