Provider Demographics
NPI:1477651537
Name:NICHOLS, BRUCE ANDREW (RPH)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:ANDREW
Last Name:NICHOLS
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 1:4409 E WOODGLEN RD
Mailing Address - Street 2:
Mailing Address - City:MEAD
Mailing Address - State:WA
Mailing Address - Zip Code:99021-9451
Mailing Address - Country:US
Mailing Address - Phone:509-464-4242
Mailing Address - Fax:
Practice Address - Street 1:14202 N MARKET ST
Practice Address - Street 2:
Practice Address - City:MEAD
Practice Address - State:WA
Practice Address - Zip Code:99021-9524
Practice Address - Country:US
Practice Address - Phone:509-242-0201
Practice Address - Fax:509-242-0203
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00019886183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist