Provider Demographics
NPI:1477005478
Name:NICHOLAS, DEBRA STEVENS (RPH)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:STEVENS
Last Name:NICHOLAS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 WILLOW BND
Mailing Address - Street 2:
Mailing Address - City:CANDLER
Mailing Address - State:NC
Mailing Address - Zip Code:28715-8728
Mailing Address - Country:US
Mailing Address - Phone:618-889-6001
Mailing Address - Fax:
Practice Address - Street 1:72 WILLOW BND
Practice Address - Street 2:
Practice Address - City:CANDLER
Practice Address - State:NC
Practice Address - Zip Code:28715-8728
Practice Address - Country:US
Practice Address - Phone:618-889-6001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25937183500000X
TN8032183500000X
IL051.289817183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist