Provider Demographics
NPI:1538523139
Name:MACNICHOL, SAMUEL CHARLES (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:CHARLES
Last Name:MACNICHOL
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 1:24 WHIPS LN
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-4856
Mailing Address - Country:US
Mailing Address - Phone:443-904-7030
Mailing Address - Fax:
Practice Address - Street 1:24 WHIPS LN
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-4856
Practice Address - Country:US
Practice Address - Phone:443-904-7030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-09
Last Update Date:2016-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23310183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist