Provider Demographics
NPI:1750979092
Name:PEIRCE, NICHOLAS (RPH)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:PEIRCE
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 1:30 BELGRADE AVE
Mailing Address - Street 2:
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-3006
Mailing Address - Country:US
Mailing Address - Phone:617-327-0210
Mailing Address - Fax:617-323-8776
Practice Address - Street 1:30 BELGRADE AVE
Practice Address - Street 2:
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131-3006
Practice Address - Country:US
Practice Address - Phone:617-327-0210
Practice Address - Fax:617-323-8776
Is Sole Proprietor?:No
Enumeration Date:2021-01-04
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH237610183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist