Provider Demographics
NPI:1437164027
Name:NICHOLS PHARMACY INC
Entity Type:Organization
Organization Name:NICHOLS PHARMACY INC
Other - Org Name:NICHOLS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES CHIEF PHARM
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PINDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-786-4004
Mailing Address - Street 1:PO BOX 355
Mailing Address - Street 2:
Mailing Address - City:DEQUINCY
Mailing Address - State:LA
Mailing Address - Zip Code:70633-0355
Mailing Address - Country:US
Mailing Address - Phone:337-786-4000
Mailing Address - Fax:337-786-4005
Practice Address - Street 1:915 E FOURTH ST
Practice Address - Street 2:
Practice Address - City:DEQUINCY
Practice Address - State:LA
Practice Address - Zip Code:70633-3709
Practice Address - Country:US
Practice Address - Phone:337-786-4004
Practice Address - Fax:337-786-4005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPHY000818IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1231541Medicaid
1904944OtherNCPDP PROVIDER IDENTIFICATION NUMBER