Provider Demographics
NPI:1174123640
Name:NICHOLS, DAVID EDWARD
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:EDWARD
Last Name:NICHOLS
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 1:2351 CENTURY DR
Mailing Address - Street 2:
Mailing Address - City:WEST MIFFLIN
Mailing Address - State:PA
Mailing Address - Zip Code:15122-2430
Mailing Address - Country:US
Mailing Address - Phone:412-655-3909
Mailing Address - Fax:412-655-0816
Practice Address - Street 1:2351 CENTURY DR
Practice Address - Street 2:
Practice Address - City:WEST MIFFLIN
Practice Address - State:PA
Practice Address - Zip Code:15122-2430
Practice Address - Country:US
Practice Address - Phone:412-655-3909
Practice Address - Fax:412-655-0816
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP439712183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist