Provider Demographics
NPI:1295047637
Name:NICHOLS, WILBUR (RPH)
Entity type:Individual
Prefix:
First Name:WILBUR
Middle Name:
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 1:101 WOODSONG ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77611-3764
Mailing Address - Country:US
Mailing Address - Phone:409-735-4811
Mailing Address - Fax:
Practice Address - Street 1:1790 TEXAS AVE
Practice Address - Street 2:
Practice Address - City:BRIDGE CITY
Practice Address - State:TX
Practice Address - Zip Code:77611-3531
Practice Address - Country:US
Practice Address - Phone:409-792-0597
Practice Address - Fax:409-792-0052
Is Sole Proprietor?:No
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22914183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist