Provider Demographics
NPI:1376116889
Name:DINEHART, NICHOLAS R (PHARMD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:R
Last Name:DINEHART
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 E PICKARD ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-1062
Mailing Address - Country:US
Mailing Address - Phone:989-775-2110
Mailing Address - Fax:
Practice Address - Street 1:1015 E PICKARD ST
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-1062
Practice Address - Country:US
Practice Address - Phone:989-775-2110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302413522183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist