Provider Demographics
NPI:1356866461
Name:RALPH, NICHOLAS A (PHARM D)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:A
Last Name:RALPH
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8450 SEYMOUR RD
Mailing Address - Street 2:
Mailing Address - City:GAINES
Mailing Address - State:MI
Mailing Address - Zip Code:48436-9774
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8360 S SAGINAW ST
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-1850
Practice Address - Country:US
Practice Address - Phone:810-694-2500
Practice Address - Fax:810-606-8381
Is Sole Proprietor?:No
Enumeration Date:2017-08-09
Last Update Date:2017-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302042142183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist