Provider Demographics
NPI:1477095495
Name:NICHOLLS, JORDAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:
Last Name:NICHOLLS
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 1:210 PROVIDENCE HILL DR
Mailing Address - Street 2:APT. 146
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-2294
Mailing Address - Country:US
Mailing Address - Phone:937-903-9168
Mailing Address - Fax:
Practice Address - Street 1:210 PROVIDENCE HILL DR
Practice Address - Street 2:APT. 146
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2294
Practice Address - Country:US
Practice Address - Phone:937-903-9168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-08
Last Update Date:2021-03-31
Deactivation Date:2019-07-28
Deactivation Code:
Reactivation Date:2021-03-31
Provider Licenses
StateLicense IDTaxonomies
OH03236575183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist