Provider Demographics
NPI:1982233227
Name:NICHOLS, KAYLA ANNE (PHARMD, BCCCP)
Entity Type:Individual
Prefix:DR
First Name:KAYLA
Middle Name:ANNE
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:PHARMD, BCCCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:361 17TH ST NW UNIT 2013
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30363-1090
Mailing Address - Country:US
Mailing Address - Phone:904-392-9588
Mailing Address - Fax:
Practice Address - Street 1:1365 CLIFTON RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1013
Practice Address - Country:US
Practice Address - Phone:904-392-9588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-08
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH0292291835C0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835C0205XPharmacy Service ProvidersPharmacistCritical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS55118OtherFLORIDA PHARMACIST LICENSE
GARPH029229OtherGEORGIA PHARMACIST LICENSE
7152015OtherBOARD OF PHARMACY SPECIALTIES BCCCP