Provider Demographics
NPI:1891881983
Name:COLDEN, NICHOLAS DEAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:DEAN
Last Name:COLDEN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1430 ARROYO VISTA DR
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-7988
Mailing Address - Country:US
Mailing Address - Phone:386-717-3331
Mailing Address - Fax:386-740-1333
Practice Address - Street 1:2400 S WOODLAND BLVD
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-8636
Practice Address - Country:US
Practice Address - Phone:386-734-5369
Practice Address - Fax:386-740-1333
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS26163183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist