Provider Demographics
NPI:1356025985
Name:NICHOLASVILLE PHARMACIST GROUP
Entity type:Organization
Organization Name:NICHOLASVILLE PHARMACIST GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:CPHT
Authorized Official - Phone:859-354-2100
Mailing Address - Street 1:1025 N MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-2312
Mailing Address - Country:US
Mailing Address - Phone:859-354-2100
Mailing Address - Fax:859-354-2101
Practice Address - Street 1:1025 N MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-2312
Practice Address - Country:US
Practice Address - Phone:859-354-2100
Practice Address - Fax:859-354-2101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy