Provider Demographics
NPI:1225620461
Name:BARTOW, NICHOLAS JR (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:
Last Name:BARTOW
Suffix:JR
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 E BARNETT RD STE 1
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8380
Mailing Address - Country:US
Mailing Address - Phone:541-789-5850
Mailing Address - Fax:
Practice Address - Street 1:2800 E BARNETT RD
Practice Address - Street 2:SUITE 1
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504
Practice Address - Country:US
Practice Address - Phone:541-789-5805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-09
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0018664183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist