Provider Demographics
NPI:1376127449
Name:BRISBOIS, NICHOLAS K (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:K
Last Name:BRISBOIS
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 1:185 FARNSWORTH ST
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01013-2864
Mailing Address - Country:US
Mailing Address - Phone:413-221-2257
Mailing Address - Fax:
Practice Address - Street 1:1322 BEACON ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-3701
Practice Address - Country:US
Practice Address - Phone:617-731-4410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH239926183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty