Charles Douglas Nickels, R. PH.

Primary specialty

PharmacistTaxonomy code 183500000X

License

042457 Issued in MO

Practice address

1 Flower Valley Shopping Ctr
Florissant, MO 63033-1644

Phone

(314) 831-8400

Fax

(314) 831-3649

NPI assigned

Mar 7, 2012

Last updated

Mar 7, 2012By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Pharmacist

State licenses

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

{
    "created_epoch": "1331078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1331078400000",
    "number": "1770857880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 FLOWER VALLEY SHOPPING CTR",
            "city": "FLORISSANT",
            "state": "MO",
            "postal_code": "630331644",
            "telephone_number": "314-831-8400",
            "fax_number": "314-831-3649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 FLOWER VALLEY SHOPPING CTR",
            "city": "FLORISSANT",
            "state": "MO",
            "postal_code": "630331644",
            "telephone_number": "314-831-8400",
            "fax_number": "314-831-3649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICKELS",
        "first_name": "CHARLES",
        "middle_name": "DOUGLAS",
        "name_prefix": "Mr.",
        "credential": "R. PH.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-03-07",
        "last_updated": "2012-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MO",
            "license": "042457",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pharmacist in Florissant, MO
• Providers in Florissant, MO by specialty
• Pharmacist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.