Provider Demographics
NPI:1992361133
Name:NICHOLS, GEORGETTE CAROLYN (PHARMD)
Entity type:Individual
Prefix:MISS
First Name:GEORGETTE
Middle Name:CAROLYN
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 W ROYALL BLVD
Mailing Address - Street 2:
Mailing Address - City:MALAKOFF
Mailing Address - State:TX
Mailing Address - Zip Code:75148-9499
Mailing Address - Country:US
Mailing Address - Phone:903-489-1909
Mailing Address - Fax:
Practice Address - Street 1:409 W ROYALL BLVD
Practice Address - Street 2:
Practice Address - City:MALAKOFF
Practice Address - State:TX
Practice Address - Zip Code:75148-9499
Practice Address - Country:US
Practice Address - Phone:903-489-1909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-14
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34643336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy