Provider Demographics
NPI:1700168838
Name:GULLETT, NICHOLAS LEO (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:LEO
Last Name:GULLETT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 SOUTH STATE STREET
Mailing Address - Street 2:
Mailing Address - City:YADKINVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27055
Mailing Address - Country:US
Mailing Address - Phone:336-679-8849
Mailing Address - Fax:336-679-4719
Practice Address - Street 1:921 S STATE ST
Practice Address - Street 2:
Practice Address - City:YADKINVILLE
Practice Address - State:NC
Practice Address - Zip Code:27055-6765
Practice Address - Country:US
Practice Address - Phone:336-679-8849
Practice Address - Fax:336-679-4719
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21893183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist