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Individual
JAKE NICHOLS
Active
Individual
JAKE NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARM.D., MBA
Taxonomy
Speciality
Code
Description
License number
State
1835P1200X
Pharmacotherapy Pharmacist
024752
MA
1835P1300X
Psychiatric Pharmacist
Primary
024752
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
024752
MASSACHUSETTS PHARMACY LICENSE
MA
Enumeration date
12/14/2009
Last updated
10/07/2015
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