Provider Demographics
NPI:1154959146
Name:VOGEL, NICKOLAS PETER (PHARMD)
Entity type:Individual
Prefix:MR
First Name:NICKOLAS
Middle Name:PETER
Last Name:VOGEL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29466 KILGORE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:DAVIS CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50065-4283
Mailing Address - Country:US
Mailing Address - Phone:515-971-5944
Mailing Address - Fax:
Practice Address - Street 1:504 N CLEVELAND ST
Practice Address - Street 2:
Practice Address - City:MOUNT AYR
Practice Address - State:IA
Practice Address - Zip Code:50854-2201
Practice Address - Country:US
Practice Address - Phone:641-464-4413
Practice Address - Fax:641-464-4453
Is Sole Proprietor?:No
Enumeration Date:2020-03-27
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21593183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist