Provider Demographics
NPI:1467505917
Name:NYKANEN, DOUGLAS EUGENE (RPH)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:EUGENE
Last Name:NYKANEN
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 1:733 MAPLE LEAF DR
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:WI
Mailing Address - Zip Code:54020-4302
Mailing Address - Country:US
Mailing Address - Phone:715-294-2766
Mailing Address - Fax:715-294-1617
Practice Address - Street 1:120 CASCADE ST N
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:WI
Practice Address - Zip Code:54020
Practice Address - Country:US
Practice Address - Phone:715-294-2110
Practice Address - Fax:715-294-1617
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7702-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist