Provider Demographics
NPI:1649382599
Name:NICHOLASVILLE PHARMACY SERVICES INC
Entity Type:Organization
Organization Name:NICHOLASVILLE PHARMACY SERVICES INC
Other - Org Name:THE PRESCRIPTION PAD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DOWNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-887-2841
Mailing Address - Street 1:465 KEENE CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-1492
Mailing Address - Country:US
Mailing Address - Phone:859-887-2841
Mailing Address - Fax:859-887-1340
Practice Address - Street 1:465 KEENE CENTRE DR
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-1492
Practice Address - Country:US
Practice Address - Phone:859-887-2841
Practice Address - Fax:859-887-1340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336L0003X
KYP018183336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2126987OtherPK