Provider Demographics
NPI:1447805783
Name:HARMON, NICHOLAS (PHARMD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:HARMON
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:PO BOX 205
Mailing Address - Street 2:
Mailing Address - City:MAVISDALE
Mailing Address - State:VA
Mailing Address - Zip Code:24627-0205
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5638 REDBUD HIGHWAY
Practice Address - Street 2:
Practice Address - City:HONAKER
Practice Address - State:VA
Practice Address - Zip Code:24260-2426
Practice Address - Country:US
Practice Address - Phone:276-873-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202218006183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist