Provider Demographics
NPI:1447806534
Name:NICHOLS, MOLLY ANNABELLE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:ANNABELLE
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:ANNABELLE
Other - Last Name:AGNEW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:873 W CARMEL DR
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-5804
Mailing Address - Country:US
Mailing Address - Phone:317-580-0260
Mailing Address - Fax:
Practice Address - Street 1:7120 CLEARVISTA DR STE 1900
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1569
Practice Address - Country:US
Practice Address - Phone:317-567-2651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26028390A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist