Provider Demographics
NPI:1528341534
Name:NICHOLS, AMANDA ELIZABETH (BS PHARMACY)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:ELIZABETH
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:BS PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 CREPE MYRTLE DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-7829
Mailing Address - Country:US
Mailing Address - Phone:870-268-1442
Mailing Address - Fax:870-268-1463
Practice Address - Street 1:1706 CREPE MYRTLE DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-7829
Practice Address - Country:US
Practice Address - Phone:870-268-1442
Practice Address - Fax:870-268-1463
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR 07140183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist