Provider Demographics
NPI:1801154398
Name:STAMOS, NICHOLAS S (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:S
Last Name:STAMOS
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2355 E STADIUM BLVD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-4800
Mailing Address - Country:US
Mailing Address - Phone:734-483-5695
Mailing Address - Fax:734-663-8420
Practice Address - Street 1:2355 E STADIUM BLVD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-4800
Practice Address - Country:US
Practice Address - Phone:734-483-5695
Practice Address - Fax:734-663-8420
Is Sole Proprietor?:No
Enumeration Date:2012-05-02
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302018591183500000X
NHR1564183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist