Provider Demographics
NPI:1205962305
Name:NICHOLSON, WILLIAM SPRATLEY
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:SPRATLEY
Last Name:NICHOLSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3031 WILLIAMSWOOD RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-2847
Mailing Address - Country:US
Mailing Address - Phone:804-272-9036
Mailing Address - Fax:
Practice Address - Street 1:6900 ATMORE DR RM 3127A
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-5644
Practice Address - Country:US
Practice Address - Phone:804-674-3681
Practice Address - Fax:804-674-3684
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202004586183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist