Provider Demographics
NPI:1275163206
Name:METROPOL, NICHOLAS STEPHEN
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:STEPHEN
Last Name:METROPOL
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 1:426 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:SC
Mailing Address - Zip Code:29627-1524
Mailing Address - Country:US
Mailing Address - Phone:864-338-3184
Mailing Address - Fax:
Practice Address - Street 1:426 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:SC
Practice Address - Zip Code:29627-1524
Practice Address - Country:US
Practice Address - Phone:864-338-3184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-17
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC42177183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist