# NICHOLLS PHARMACY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** NICHOLLS PHARMACY LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184748808
- **Authorized official:** JAN SCOTT RPH (OWNER,PRES,PIC,AO)
- **Authorized official phone:** (912) 345-1021

## Contact information

- **Practice address:** 1003 VAN STREAT HWY, NICHOLLS, GA 31554-5031
- **Practice address phone:** (912) 345-1021
- **Practice address fax:** (912) 345-1023
- **Mailing address:** PO BOX 247, NICHOLLS, GA 31554-0247
- **Mailing address phone:** (912) 345-1021
- **Mailing address fax:** (912) 345-1023

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | PHRE009134 | GA | Yes |

## Other

- **Enumeration date:** 03/19/2007
- **Last updated:** 09/17/2015