Individual
DR. JUSTIN D NICHOLLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD, BCOP, BCPS
Contact information
Practice address
1201 NE LLOYD BLVD, STE 510, PORTLAND, OR 97232-1202
(971) 678-9127
Mailing address
1450 N PRESCOTT ST, APT 405, PORTLAND, OR 97217-3202
(971) 678-9127
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
3984
MT
183500000X
Pharmacist
PH00052231
WA
183500000X
Pharmacist
Primary
RPH-0010070
OR
Other
Enumeration date
06/18/2005
Last updated
10/17/2014
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