Provider Demographics
NPI:1952184244
Name:GAULT, NICHOLAS ANDREW (PHARMD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:ANDREW
Last Name:GAULT
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 1:575 E AMHERST AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-1651
Mailing Address - Country:US
Mailing Address - Phone:303-919-5555
Mailing Address - Fax:
Practice Address - Street 1:757 E 20TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-3278
Practice Address - Country:US
Practice Address - Phone:303-919-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA.0024544183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist