Provider Demographics
NPI:1235223934
Name:NICHOLS, ROBERT (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
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 1:10525 LEOPARD ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78410-2601
Mailing Address - Country:US
Mailing Address - Phone:361-241-2323
Mailing Address - Fax:361-241-5541
Practice Address - Street 1:10525 LEOPARD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78410-2601
Practice Address - Country:US
Practice Address - Phone:361-241-2323
Practice Address - Fax:361-241-5541
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31651183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4516564OtherNABP
TX143320Medicaid
TX4516564OtherNABP