Provider Demographics
NPI:1679862627
Name:NICHOLS, TYLER JAYMES (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:JAYMES
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:TYLER
Other - Middle Name:JAYMES
Other - Last Name:NICHOLS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:23 FAIRFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-3471
Mailing Address - Country:US
Mailing Address - Phone:518-928-4611
Mailing Address - Fax:
Practice Address - Street 1:600 NORTHERN BLVD
Practice Address - Street 2:ALBANY MEMORIAL HOSPITAL PHARMACY
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12204-1004
Practice Address - Country:US
Practice Address - Phone:518-471-3141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-30
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054863-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist