Organization
NICHOLAS PHARMACY INC
Active
Other names
Nicholas Home Medical, NICHOLAS PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL CLARK RRT (GENERAL MANAGER)
(304) 872-0517
Entity
Organization
Contact information
Practice address
421 MAIN ST, SUMMERSVILLE, WV 26651
(304) 872-0517
(304) 872-6644
Mailing address
421 MAIN ST, SUMMERSVILLE, WV 26651-1343
(304) 872-0517
(304) 872-6644
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0143752000
—
WV
01
—
2109949
PK
—
Enumeration date
01/11/2006
Last updated
07/17/2018
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