Provider Demographics
NPI:1265690762
Name:NICHOLS, TIMOTHY W (RPH)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:W
Last Name:NICHOLS
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 1:849 TAYLORSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40071-9771
Mailing Address - Country:US
Mailing Address - Phone:502-477-2267
Mailing Address - Fax:502-477-2283
Practice Address - Street 1:849 TAYLORSVILLE RD
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40071-9771
Practice Address - Country:US
Practice Address - Phone:502-477-2267
Practice Address - Fax:502-477-2283
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-30
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY010922183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist