Provider Demographics
NPI:1740635069
Name:NICHOLSON, DEBORAH (PHARMD)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:DOEHNERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8331 N MOUNTAIN STONE PINE WAY
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85743-7487
Mailing Address - Country:US
Mailing Address - Phone:602-363-2354
Mailing Address - Fax:
Practice Address - Street 1:1350 N SILVERBELL RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2228
Practice Address - Country:US
Practice Address - Phone:520-622-2979
Practice Address - Fax:520-623-3942
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-25
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS019539183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist