Provider Demographics
NPI:1508249079
Name:NICHOLS, RALPH VERNELL (RPH)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:VERNELL
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 1:2905 BLUE RIDGE DR E
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36693-3302
Mailing Address - Country:US
Mailing Address - Phone:251-452-0531
Mailing Address - Fax:251-456-1529
Practice Address - Street 1:414 NORTH CRAFT HIGHWAY
Practice Address - Street 2:
Practice Address - City:CHICKASAW
Practice Address - State:AL
Practice Address - Zip Code:36611
Practice Address - Country:US
Practice Address - Phone:251-452-0521
Practice Address - Fax:251-456-1529
Is Sole Proprietor?:No
Enumeration Date:2015-07-02
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7595183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist