Basic Information
| Provider Information | |||||||||
| NPI: | 1154661684 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NICHOLS | ||||||||
| FirstName: | COREY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARM.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 3633 GRAY AVE | ||||||||
| Address2: | |||||||||
| City: | ADAMSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 350052238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2056741400 | ||||||||
| FaxNumber: | 2056741525 | ||||||||
| Practice Location | |||||||||
| Address1: | 3633 GRAY AVE | ||||||||
| Address2: | |||||||||
| City: | ADAMSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 350052238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2056741400 | ||||||||
| FaxNumber: | 2056741525 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2013 | ||||||||
| LastUpdateDate: | 02/20/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 15829 | AL | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.