Provider Demographics
NPI:1841598877
Name:TATE, NICHOLAS ADAM
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:ADAM
Last Name:TATE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 FOREST DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-4003
Mailing Address - Country:US
Mailing Address - Phone:803-743-4373
Mailing Address - Fax:803-743-4375
Practice Address - Street 1:3501 FOREST DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-4003
Practice Address - Country:US
Practice Address - Phone:803-743-4373
Practice Address - Fax:803-743-4375
Is Sole Proprietor?:No
Enumeration Date:2011-02-28
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist