Provider Demographics
NPI:1437178100
Name:NICHOLS, STEPHNAIE JOHNSON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHNAIE
Middle Name:JOHNSON
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:STEPHANIE
Other - Middle Name:LEE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:1920 HIDDEN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37914-9220
Mailing Address - Country:US
Mailing Address - Phone:865-525-7893
Mailing Address - Fax:865-545-4488
Practice Address - Street 1:9031 CROSS PARK DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4602
Practice Address - Country:US
Practice Address - Phone:865-545-4532
Practice Address - Fax:865-545-4488
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN120661835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy