Provider Demographics
NPI:1346813482
Name:NICHOLSON, SPENCER (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:SPENCER
Middle Name:
Last Name:NICHOLSON
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 SHILOH RD UNIT 2409
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59106-2760
Mailing Address - Country:US
Mailing Address - Phone:406-564-0861
Mailing Address - Fax:
Practice Address - Street 1:670 MAIN ST
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59105-3224
Practice Address - Country:US
Practice Address - Phone:406-245-0470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPHA-PHA-LIC-79447183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist