Provider Demographics
NPI:1851606982
Name:NICHOLS, CHARLOTTE WILLIS (RPH)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:WILLIS
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 NORTHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36067-7019
Mailing Address - Country:US
Mailing Address - Phone:334-361-1719
Mailing Address - Fax:
Practice Address - Street 1:1011 PERRY HILL RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36109-4521
Practice Address - Country:US
Practice Address - Phone:334-270-0660
Practice Address - Fax:334-273-9791
Is Sole Proprietor?:No
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9977183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist