Provider Demographics
NPI:1891136776
Name:O'CONNELL, NICHOLAS DREW (PHARMD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:DREW
Last Name:O'CONNELL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 N HIGHWAY 190
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-5147
Mailing Address - Country:US
Mailing Address - Phone:985-893-9918
Mailing Address - Fax:
Practice Address - Street 1:880 N HIGHWAY 190
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-5147
Practice Address - Country:US
Practice Address - Phone:985-893-9918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-08
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA20175183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA20175OtherPHARMACIST LICENSE NUMBER