Provider Demographics
NPI:1215224415
Name:NICKS, KRISTIE JORDAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIE
Middle Name:JORDAN
Last Name:NICKS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2042 RANKIN MILL RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-9544
Mailing Address - Country:US
Mailing Address - Phone:336-375-3616
Mailing Address - Fax:336-954-9650
Practice Address - Street 1:2042 RANKIN MILL RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-9544
Practice Address - Country:US
Practice Address - Phone:336-375-3616
Practice Address - Fax:336-954-9650
Is Sole Proprietor?:No
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18250183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist