Provider Demographics
NPI:1578163069
Name:NIELSON, ALARIC MICHAEL
Entity Type:Individual
Prefix:DR
First Name:ALARIC
Middle Name:MICHAEL
Last Name:NIELSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 SCHOOLCRAFT ST
Mailing Address - Street 2:
Mailing Address - City:LAKE LINDEN
Mailing Address - State:MI
Mailing Address - Zip Code:49945-1328
Mailing Address - Country:US
Mailing Address - Phone:479-360-8604
Mailing Address - Fax:
Practice Address - Street 1:158 SCHOOLCRAFT ST
Practice Address - Street 2:
Practice Address - City:LAKE LINDEN
Practice Address - State:MI
Practice Address - Zip Code:49945-1328
Practice Address - Country:US
Practice Address - Phone:479-360-8604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX547861835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX54786OtherPHARMACIST LICENSE