Justin D Nicholls, PHARMD, BCOP, BCPS

Primary specialty

PharmacistTaxonomy code 183500000X

License

RPH-0010070 Issued in OR

Practice address

1201 NE Lloyd Blvd
Ste 510
Portland, OR 97232-1202

Phone

(971) 678-9127

NPI assigned

Jun 18, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

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

{
    "created_epoch": "1119052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1413504000000",
    "number": "1891790549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1450 N PRESCOTT ST",
            "address_2": "APT 405",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972173202",
            "telephone_number": "971-678-9127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 NE LLOYD BLVD",
            "address_2": "STE 510",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972321202",
            "telephone_number": "971-678-9127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLLS",
        "first_name": "JUSTIN",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "PHARMD, BCOP, BCPS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-18",
        "last_updated": "2014-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MT",
            "license": "3984",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "OR",
            "license": "RPH-0010070",
            "primary": true
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "WA",
            "license": "PH00052231",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leslie Victoria Nicholas, N.D.
• Robert Nicholas
• Veronica Nicholas
• Eli Nicholes, MSW
• Melinda Sue Nicholes, DPM
• Larry Michael Nicholls
• Lindsay A Nichols Hughes
• Amanda Rae Nichols, CD(DONA)
• Benjamin Francis Nichols
• Dane J Nichols, MD

• Pharmacist in Portland, OR
• Providers in Portland, OR by specialty
• Pharmacist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 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.

Verify at the official NPI Registry.