Provider Demographics
NPI:1407445729
Name:DENNIE, NICHOLAS TYLER
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:TYLER
Last Name:DENNIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:949 WILLIAM D FITCH PKWY
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-4638
Mailing Address - Country:US
Mailing Address - Phone:979-690-4690
Mailing Address - Fax:
Practice Address - Street 1:949 WILLIAM D FITCH PKWY
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-4638
Practice Address - Country:US
Practice Address - Phone:979-690-4690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician