Provider Demographics
NPI:1861202392
Name:IRELAND, NICHOLAS
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:
Last Name:IRELAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 DYLAN AVE
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-8188
Mailing Address - Country:US
Mailing Address - Phone:207-447-1026
Mailing Address - Fax:
Practice Address - Street 1:820 WATERBURY STOWE RD
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:VT
Practice Address - Zip Code:05676
Practice Address - Country:US
Practice Address - Phone:802-241-4115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0330135543183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist