Provider Demographics
NPI:1740344506
Name:NUCKOLS, STEVE (RPH)
Entity type:Individual
Prefix:MR
First Name:STEVE
Middle Name:
Last Name:NUCKOLS
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 1:7075 HIGHFIELDS FARM CIR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-5639
Mailing Address - Country:US
Mailing Address - Phone:540-774-3634
Mailing Address - Fax:540-772-0601
Practice Address - Street 1:7075 HIGHFIELDS FARM CIR
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-5639
Practice Address - Country:US
Practice Address - Phone:540-774-3634
Practice Address - Fax:540-772-0601
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202004587183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist