Provider Demographics
NPI:1780178640
Name:GILLESPIE, NICHOLAS ANDREW (PHARMD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:ANDREW
Last Name:GILLESPIE
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 1:125 MOUNTAINVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36109-4107
Mailing Address - Country:US
Mailing Address - Phone:334-221-9193
Mailing Address - Fax:
Practice Address - Street 1:3300 S OATES ST
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-5694
Practice Address - Country:US
Practice Address - Phone:334-702-0840
Practice Address - Fax:334-702-0580
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL199473336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL19947OtherALABAMA STATE BOARD OF PHARMACY