Nicholls Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHRE009134 Issued in GA

Legal business name

NICHOLLS PHARMACY LLC

Doing business as

Nicholls Pharmacy LLC

Practice address

1003 Van Streat Hwy
Nicholls, GA 31554-5031

Phone

(912) 345-1021

Fax

(912) 345-1023

NPI assigned

Mar 19, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jan Scott, RPHNPI 1720129042

Title

Owner,Pres,Pic,Ao

Phone

(912) 345-1021

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• NICHOLLS PHARMACY LLC Doing business as

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jan G. Scott, PHARM D.

  • Pharmacist
  • Douglas, GA
  • NPI 1720129042
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1442448000000",
    "number": "1184748808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 247",
            "city": "NICHOLLS",
            "state": "GA",
            "postal_code": "315540247",
            "telephone_number": "912-345-1021",
            "fax_number": "912-345-1023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1003 VAN STREAT HWY",
            "city": "NICHOLLS",
            "state": "GA",
            "postal_code": "315545031",
            "telephone_number": "912-345-1021",
            "fax_number": "912-345-1023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NICHOLLS PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-19",
        "last_updated": "2015-09-17",
        "status": "A",
        "authorized_official_last_name": "SCOTT",
        "authorized_official_first_name": "JAN",
        "authorized_official_title_or_position": "OWNER,PRES,PIC,AO",
        "authorized_official_telephone_number": "912-345-1021",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "GA",
            "license": "PHRE009134",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "569772164A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2016489",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NICHOLLS PHARMACY LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Pamela C. Lee, APRN, BC
• Brad M Mobley, PHARMOCIST
• Nicholls Clinic
• Nicholls Family Health Care, P.C.
• Nicholls Pharmacy
• Tanisha Shuante Riles
• Hope Elizabeth Schermerhorn, CNA
• Myra Sellers, CCC-SLP
• SLB Diagnostic Solution LLC
• South East EMS LLC (South East EMS)

• Community/Retail Pharmacy in Nicholls, GA
• Providers in Nicholls, GA by specialty
• Community/Retail Pharmacy in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.