Individual
MR. DAVID EUGENE NICKLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPH
Contact information
Practice address
1442 N HARRISON ST, SHAWNEE, OK 74801-5208
(405) 273-9906
(405) 273-4329
Mailing address
1807 HENSON CT, SHAWNEE, OK 74804-4240
(405) 275-6169
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
9416
OK
Other
Enumeration date
08/09/2006
Last updated
07/08/2007
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