Provider Demographics
NPI:1013511807
Name:NICKEL, CHLOE GRACE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CHLOE
Middle Name:GRACE
Last Name:NICKEL
Suffix:
Gender:
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 EARHART DR STE 101
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7079
Mailing Address - Country:US
Mailing Address - Phone:716-875-0922
Mailing Address - Fax:
Practice Address - Street 1:15 EARHART DR STE 101
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14221-7079
Practice Address - Country:US
Practice Address - Phone:716-875-0922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-23
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY065098183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist