Provider Demographics
NPI:1497847842
Name:NICHOLS, DEBORA ANITA (RPH)
Entity type:Individual
Prefix:
First Name:DEBORA
Middle Name:ANITA
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 MCMILLAN ROAD
Mailing Address - Street 2:
Mailing Address - City:NOTASULGA
Mailing Address - State:AL
Mailing Address - Zip Code:36866
Mailing Address - Country:US
Mailing Address - Phone:334-727-0550
Mailing Address - Fax:
Practice Address - Street 1:2400 HOSPITAL ROAD
Practice Address - Street 2:
Practice Address - City:TUSKEGEE
Practice Address - State:AL
Practice Address - Zip Code:36083
Practice Address - Country:US
Practice Address - Phone:334-727-0550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10492183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist