Provider Demographics
NPI:1255757399
Name:NICHOLSON, SCOTT GALEN (RPH)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:GALEN
Last Name:NICHOLSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3215 SW MACVICAR AVE
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66611-1836
Mailing Address - Country:US
Mailing Address - Phone:785-783-3041
Mailing Address - Fax:
Practice Address - Street 1:3215 SW MACVICAR AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66611-1836
Practice Address - Country:US
Practice Address - Phone:785-783-3041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS10573183500000X
MO2013016827183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist