Provider Demographics
NPI:1487043212
Name:NICHOLAS, JEFFREY (PHARMD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:NICHOLAS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:JEFFREY
Other - Middle Name:
Other - Last Name:RAMSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1121 S US HIGHWAY 25E
Mailing Address - Street 2:
Mailing Address - City:BARBOURVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40906-8005
Mailing Address - Country:US
Mailing Address - Phone:606-545-0539
Mailing Address - Fax:
Practice Address - Street 1:1121 S US HIGHWAY 25E
Practice Address - Street 2:
Practice Address - City:BARBOURVILLE
Practice Address - State:KY
Practice Address - Zip Code:40906-8005
Practice Address - Country:US
Practice Address - Phone:606-545-0539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-16
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY017150183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist