Provider Demographics
NPI:1164740106
Name:NICHOLS, DERICK G (RPH)
Entity Type:Individual
Prefix:MR
First Name:DERICK
Middle Name:G
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 1:14 PETERBOROUGH ST
Mailing Address - Street 2:
Mailing Address - City:JAFFREY
Mailing Address - State:NH
Mailing Address - Zip Code:03452-5857
Mailing Address - Country:US
Mailing Address - Phone:603-532-6955
Mailing Address - Fax:
Practice Address - Street 1:14 PETERBOROUGH ST
Practice Address - Street 2:
Practice Address - City:JAFFREY
Practice Address - State:NH
Practice Address - Zip Code:03452-5857
Practice Address - Country:US
Practice Address - Phone:603-532-6955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-14
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2593183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist