Provider Demographics
NPI:1144490715
Name:NICKELLS, SUZANNE PEEPLES (PHARMACIST)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:PEEPLES
Last Name:NICKELLS
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5171 SAM JARED DR
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-1382
Mailing Address - Country:US
Mailing Address - Phone:615-867-3504
Mailing Address - Fax:615-867-5421
Practice Address - Street 1:5171 SAM JARED DR
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-1382
Practice Address - Country:US
Practice Address - Phone:615-867-3504
Practice Address - Fax:615-867-5421
Is Sole Proprietor?:No
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3278183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist