Provider Demographics
NPI:1992300842
Name:NICKELE, CHRISTOPHER MARK (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:MARK
Last Name:NICKELE
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 1:2440 WABASH AVE
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807-3310
Mailing Address - Country:US
Mailing Address - Phone:812-235-4322
Mailing Address - Fax:812-235-1562
Practice Address - Street 1:2440 WABASH AVE
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807-3310
Practice Address - Country:US
Practice Address - Phone:812-235-4322
Practice Address - Fax:812-235-1562
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26022205A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty