Provider Demographics
NPI:1538336276
Name:NICHOLAS, STEPHEN PAUL (DPH)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:PAUL
Last Name:NICHOLAS
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 E CHEROKEE ST
Mailing Address - Street 2:
Mailing Address - City:WAGONER
Mailing Address - State:OK
Mailing Address - Zip Code:74467-4706
Mailing Address - Country:US
Mailing Address - Phone:918-485-2317
Mailing Address - Fax:918-485-8483
Practice Address - Street 1:326 E CHEROKEE ST
Practice Address - Street 2:
Practice Address - City:WAGONER
Practice Address - State:OK
Practice Address - Zip Code:74467-4706
Practice Address - Country:US
Practice Address - Phone:918-485-2317
Practice Address - Fax:918-485-8493
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11307183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist