Provider Demographics
NPI:1518567635
Name:NICHOLSON, SYLVIA ANN (RPH)
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:ANN
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:SYLVIA
Other - Middle Name:ANN
Other - Last Name:GARLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:4905 HOLDEN CIR
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-7421
Mailing Address - Country:US
Mailing Address - Phone:979-255-1251
Mailing Address - Fax:
Practice Address - Street 1:1405 EARL RUDDER FWY S
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-6033
Practice Address - Country:US
Practice Address - Phone:979-696-0128
Practice Address - Fax:979-696-0179
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33026183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist