Provider Demographics
NPI:1841937935
Name:LEGRAND, NICHOLAS JAMES
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:JAMES
Last Name:LEGRAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 W. FIRST ST PO BOX 739
Mailing Address - Street 2:
Mailing Address - City:MARBLE HILL
Mailing Address - State:MO
Mailing Address - Zip Code:63764-9218
Mailing Address - Country:US
Mailing Address - Phone:573-238-4177
Mailing Address - Fax:573-238-4986
Practice Address - Street 1:106 W. FIRST ST.
Practice Address - Street 2:
Practice Address - City:MARBLE HILL
Practice Address - State:MO
Practice Address - Zip Code:63764-9218
Practice Address - Country:US
Practice Address - Phone:573-238-4177
Practice Address - Fax:573-238-4986
Is Sole Proprietor?:No
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018028007183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist