Provider Demographics
NPI:1699813386
Name:NICHOLS, TOMMIE JO (RPH)
Entity type:Individual
Prefix:MS
First Name:TOMMIE
Middle Name:JO
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 CROTTS LN
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-6600
Mailing Address - Country:US
Mailing Address - Phone:540-293-0134
Mailing Address - Fax:540-366-7021
Practice Address - Street 1:4910 VALLEY VIEW BLVD
Practice Address - Street 2:VALLEY VIEW PHARMACY
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012
Practice Address - Country:US
Practice Address - Phone:540-366-2112
Practice Address - Fax:540-366-7210
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202008010183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist