Provider Demographics
NPI:1306027776
Name:MCNICHOLS, JAMES DALE (RPH)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:DALE
Last Name:MCNICHOLS
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 1:1100 7TH AVE S
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:MN
Mailing Address - Zip Code:55371-4555
Mailing Address - Country:US
Mailing Address - Phone:763-389-8421
Mailing Address - Fax:763-389-8454
Practice Address - Street 1:1100 7TH AVE S
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:MN
Practice Address - Zip Code:55371-4555
Practice Address - Country:US
Practice Address - Phone:763-389-8421
Practice Address - Fax:763-389-8454
Is Sole Proprietor?:No
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN112366183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist