Provider Demographics
NPI:1356499461
Name:NICHOLS, STEVEN ANDREW (RPH)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:ANDREW
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:PO BOX 2121
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:GA
Mailing Address - Zip Code:30525-0054
Mailing Address - Country:US
Mailing Address - Phone:706-782-2217
Mailing Address - Fax:
Practice Address - Street 1:2003 FALLS RD
Practice Address - Street 2:
Practice Address - City:TOCCOA
Practice Address - State:GA
Practice Address - Zip Code:30577-9700
Practice Address - Country:US
Practice Address - Phone:706-282-4362
Practice Address - Fax:706-282-4458
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA12911183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist