Provider Demographics
NPI:1689998189
Name:NICHOLAS, RICHARD S (PHARMD, ND)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:S
Last Name:NICHOLAS
Suffix:
Gender:M
Credentials:PHARMD, ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 WINTERBROOK CIR
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37663-4409
Mailing Address - Country:US
Mailing Address - Phone:276-431-2648
Mailing Address - Fax:276-431-2082
Practice Address - Street 1:121 ADVANCED TECHNOLOGY DRIVE
Practice Address - Street 2:
Practice Address - City:DUFFIELD
Practice Address - State:VA
Practice Address - Zip Code:24244
Practice Address - Country:US
Practice Address - Phone:276-431-2648
Practice Address - Fax:276-431-2082
Is Sole Proprietor?:No
Enumeration Date:2010-03-26
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00001647175F00000X
VA0202209727183500000X
NV11096183500000X
WAPH00044799183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No175F00000XOther Service ProvidersNaturopath