Provider Demographics
NPI:1821407354
Name:PRINCE, NICHOLAS ANDREW (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:ANDREW
Last Name:PRINCE
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 1:507 FOOTHILLS PLZ
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37801-2312
Mailing Address - Country:US
Mailing Address - Phone:865-238-7436
Mailing Address - Fax:865-238-7440
Practice Address - Street 1:507 FOOTHILLS PLZ
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37801-2312
Practice Address - Country:US
Practice Address - Phone:865-238-7436
Practice Address - Fax:865-238-7440
Is Sole Proprietor?:No
Enumeration Date:2014-08-08
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37463183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist