Provider Demographics
NPI:1558610154
Name:NICKS, RONALD JR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:
Last Name:NICKS
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10428 TOSCANA ST NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-3716
Mailing Address - Country:US
Mailing Address - Phone:505-715-9757
Mailing Address - Fax:
Practice Address - Street 1:7770 JEFFERSON ST NE STE 400
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4387
Practice Address - Country:US
Practice Address - Phone:505-341-4739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00007866183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist