Provider Demographics
NPI:1497858492
Name:NICHOLS, CHARLES D (RPH)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:D
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 1:227 DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32266-4928
Mailing Address - Country:US
Mailing Address - Phone:904-241-8239
Mailing Address - Fax:
Practice Address - Street 1:1209 ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:NEPTUNE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32266-1711
Practice Address - Country:US
Practice Address - Phone:904-249-3900
Practice Address - Fax:904-249-9009
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0019225183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist