Provider Demographics
NPI:1801549704
Name:HERRMANN, NICHOLAS JOSEPH (PHARMD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:JOSEPH
Last Name:HERRMANN
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 1:311 N BALTIMORE ST
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-3209
Mailing Address - Country:US
Mailing Address - Phone:660-665-3063
Mailing Address - Fax:660-665-8456
Practice Address - Street 1:311 N BALTIMORE ST
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-3209
Practice Address - Country:US
Practice Address - Phone:660-665-3063
Practice Address - Fax:660-665-8456
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-31
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010027749183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2010027749OtherPHARMACIST