Provider Demographics
NPI:1225624109
Name:NICHOLS, TONYA RESHA (PHARM D)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:RESHA
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6929 E HIGHWAY 252
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72936-8664
Mailing Address - Country:US
Mailing Address - Phone:479-629-5282
Mailing Address - Fax:
Practice Address - Street 1:1350 W 6TH ST
Practice Address - Street 2:
Practice Address - City:WALDRON
Practice Address - State:AR
Practice Address - Zip Code:72958-2600
Practice Address - Country:US
Practice Address - Phone:479-637-1007
Practice Address - Fax:479-637-1009
Is Sole Proprietor?:No
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD08484183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist