Provider Demographics
NPI:1588270169
Name:NICKERSON, SARAH (PHARM D)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:
Last Name:NICKERSON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 TYLER WAY
Mailing Address - Street 2:
Mailing Address - City:SCOTT DEPOT
Mailing Address - State:WV
Mailing Address - Zip Code:25560-9388
Mailing Address - Country:US
Mailing Address - Phone:304-206-1319
Mailing Address - Fax:
Practice Address - Street 1:3901 TEAYS VALLEY RD
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-9604
Practice Address - Country:US
Practice Address - Phone:304-760-1123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-19
Last Update Date:2020-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV9243183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist