Provider Demographics
NPI:1801878798
Name:NICHOLAS, GARY C (RPH)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:C
Last Name:NICHOLAS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
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Mailing Address - Street 1:4029 CORLISS AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-8430
Mailing Address - Country:US
Mailing Address - Phone:206-634-1044
Mailing Address - Fax:
Practice Address - Street 1:16251 SYLVESTER RD SW
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3017
Practice Address - Country:US
Practice Address - Phone:206-431-5346
Practice Address - Fax:206-439-8559
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAPH10821183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist