Provider Demographics
NPI:1538882345
Name:WILLIAMS, NICHOLAS LEE (PHARMD)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:LEE
Last Name:WILLIAMS
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 1:640 FIVE POINTS EAST RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44903-8667
Mailing Address - Country:US
Mailing Address - Phone:419-631-6308
Mailing Address - Fax:
Practice Address - Street 1:1535 MAIN ST
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-5993
Practice Address - Country:US
Practice Address - Phone:970-674-1177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03237452183500000X
TX67472183500000X
CO0024590183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist