Provider Demographics
NPI:1275318834
Name:WATERS, NICHOLE MARIE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLE
Middle Name:MARIE
Last Name:WATERS
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 1:2155 MORRIS BAKER BLVD APT 2425
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-4784
Mailing Address - Country:US
Mailing Address - Phone:843-475-5085
Mailing Address - Fax:
Practice Address - Street 1:1401 SAM RITTENBERG BLVD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-5031
Practice Address - Country:US
Practice Address - Phone:843-852-2031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC44069183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty