Provider Demographics
NPI:1144511171
Name:DOGGENDORF, NICHOLAS MICHAEL (PHARMD)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:MICHAEL
Last Name:DOGGENDORF
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 1:1673 HIGHWAY 64 NE
Mailing Address - Street 2:
Mailing Address - City:NEW SALISBURY
Mailing Address - State:IN
Mailing Address - Zip Code:47161-8439
Mailing Address - Country:US
Mailing Address - Phone:812-347-3788
Mailing Address - Fax:
Practice Address - Street 1:1673 HIGHWAY 64 NE
Practice Address - Street 2:
Practice Address - City:NEW SALISBURY
Practice Address - State:IN
Practice Address - Zip Code:47161-8439
Practice Address - Country:US
Practice Address - Phone:812-347-3788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26023396A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist