Individual
ROGER NICOLAUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1000 ROBERT RD, GRANTS, NM 87020-4012
(505) 285-3378
(505) 285-3760
Mailing address
1000 ROBERT RD, GRANTS, NM 87020-4012
(505) 285-3378
(505) 285-3760
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RP00007208
NM
Other
Enumeration date
07/17/2014
Last updated
07/17/2014
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