Provider Demographics
NPI:1558768010
Name:NELSON, NICHOLAS MARSH (PHARM D)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:MARSH
Last Name:NELSON
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 NW 39TH ST
Mailing Address - Street 2:
Mailing Address - City:WARR ACRES
Mailing Address - State:OK
Mailing Address - Zip Code:73122-2015
Mailing Address - Country:US
Mailing Address - Phone:405-495-8258
Mailing Address - Fax:405-495-8721
Practice Address - Street 1:5901 NW 39TH ST
Practice Address - Street 2:
Practice Address - City:WARR ACRES
Practice Address - State:OK
Practice Address - Zip Code:73122-2015
Practice Address - Country:US
Practice Address - Phone:405-495-8258
Practice Address - Fax:405-495-8721
Is Sole Proprietor?:No
Enumeration Date:2014-11-28
Last Update Date:2014-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15728183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist