Provider Demographics
NPI:1639555360
Name:SMITH, NICKOLAS (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:NICKOLAS
Middle Name:
Last Name:SMITH
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 1:6028 S NC 16 HWY
Mailing Address - Street 2:
Mailing Address - City:MAIDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28650-8114
Mailing Address - Country:US
Mailing Address - Phone:704-483-9133
Mailing Address - Fax:
Practice Address - Street 1:6028 S NC 16 HWY
Practice Address - Street 2:
Practice Address - City:MAIDEN
Practice Address - State:NC
Practice Address - Zip Code:28650-8114
Practice Address - Country:US
Practice Address - Phone:704-483-9133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25358183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist