Provider Demographics
NPI:1417380692
Name:GASTON, NICHOLAS LANIER (RPH)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:LANIER
Last Name:GASTON
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 1:2806 W SUGAR CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-7307
Mailing Address - Country:US
Mailing Address - Phone:704-596-3378
Mailing Address - Fax:
Practice Address - Street 1:2806 W SUGAR CREEK RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-7307
Practice Address - Country:US
Practice Address - Phone:704-596-3378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22958183500000X
FLPS49639183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist