Provider Demographics
NPI:1508402751
Name:NIKOLAI, SUSAN L (RPH)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:NIKOLAI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2720 APPLE LN
Mailing Address - Street 2:
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501-9470
Mailing Address - Country:US
Mailing Address - Phone:715-550-1440
Mailing Address - Fax:
Practice Address - Street 1:34 S BROWN ST
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-3449
Practice Address - Country:US
Practice Address - Phone:715-420-1685
Practice Address - Fax:715-420-1373
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-22
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10839-401835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist