Active NPI
Roger Nicolaus
- Pharmacist
- Grants, NM
National Provider Identifier
1124435417
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RP00007208
- Practice address
- 1000 Robert Rd
Grants, NM 87020-4012 - Phone
- (505) 285-3378
- Fax
- (505) 285-3760
- NPI assigned
- Jul 17, 2014
- Last updated
- Jul 17, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RP00007208 | NM | Primary |
Addresses
Primary practice location
1000 Robert Rd
Grants, NM 87020-4012
Mailing address
1000 Robert Rd
Grants, NM 87020-4012
Phone (505) 285-3378
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RP00007208 | NM | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wal-Mart Stores East, LP | Past | Accepting new patients | |
| Wal-Mart Stores East LP | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Wal-Mart Pharmacy 10-2652
- Community/Retail Pharmacy
- Grants, NM
- NPI 1518984665
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1405555200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1405555200000",
"number": "1124435417",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1000 ROBERT RD",
"city": "GRANTS",
"state": "NM",
"postal_code": "870204012",
"telephone_number": "505-285-3378",
"fax_number": "505-285-3760"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 ROBERT RD",
"city": "GRANTS",
"state": "NM",
"postal_code": "870204012",
"telephone_number": "505-285-3378",
"fax_number": "505-285-3760"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICOLAUS",
"first_name": "ROGER",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-07-17",
"last_updated": "2014-07-17",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NM",
"license": "RP00007208",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grants, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.