Provider Demographics
NPI:1023326584
Name:NICHOLS, TRINITY K (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TRINITY
Middle Name:K
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 HOTZEE RD
Mailing Address - Street 2:
Mailing Address - City:MANTACHIE
Mailing Address - State:MS
Mailing Address - Zip Code:38855-8053
Mailing Address - Country:US
Mailing Address - Phone:662-282-4245
Mailing Address - Fax:
Practice Address - Street 1:67 WATSON DR
Practice Address - Street 2:
Practice Address - City:MANTACHIE
Practice Address - State:MS
Practice Address - Zip Code:38855-8390
Practice Address - Country:US
Practice Address - Phone:662-282-4245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-18
Last Update Date:2010-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE09920183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist