Provider Demographics
NPI:1245979350
Name:ATHERTON, NICHOLAS GRANT (PHARMACY TECHNICIAN)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:GRANT
Last Name:ATHERTON
Suffix:
Gender:M
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 N EDMOND ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-3614
Mailing Address - Country:US
Mailing Address - Phone:229-200-3605
Mailing Address - Fax:
Practice Address - Street 1:410 S 32ND ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-5007
Practice Address - Country:US
Practice Address - Phone:918-683-0611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK22710183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician