JERALD LEE NICKELSON (NPI# 1457743080) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457743080 |
| Entity Type | Individual |
| Full Name | JERALD LEE NICKELSON |
| Practice Address |
1400 E Palomar St Chula Vista CA 91913-1800 |
| Practice Telephone | 6193973072 |
| Practice Fax Number | 6193973375 |
| Mailing Telephone | 6193973072 |
| Enumeration Date | 2015-02-18 |
| Last Update Date | 2015-02-18 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 183500000X | Pharmacist | 42174 | CA | Pharmacy Service Providers |
| Street Address |
1400 E PALOMAR ST |
| City | CHULA VISTA |
| State | CA |
| Zip Code | 91913-1800 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205823929 | Farschad K Birdjandi | Internal Medicine | 1400 E Palomar St, Chula Vista, CA 91913-1800 | 2005-09-29 |
| 1932662707 | David Chung | Physical Therapist | 1400 E Palomar St, Chula Vista, CA 91913-1800 | 2019-04-09 |
| 1487170494 | Ashley See | Physical Therapist | 1400 E Palomar St, Chula Vista, CA 91913-1800 | 2017-08-22 |
| 1891145249 | Rhian Hardee | Speech-Language Pathologist | 1400 E Palomar St, Chula Vista, CA 91913-1800 | 2016-06-16 |
| 1154708378 | Susy Grajeda Tsuruta | Pediatrics | 1400 E Palomar St, Chula Vista, CA 91913 | 2015-04-27 |
| 1568859411 | Sheri Ann Borbon Cameron | Internal Medicine | 1400 E Palomar St, Chula Vista, CA 91913 | 2015-04-17 |
| 1700284817 | Jocelyn Tam | Pharmacist | 1400 E Palomar St, Chula Vista, CA 91913-1800 | 2014-12-05 |
| 1023416104 | Richard Bonnoront | Pharmacist | 1400 E Palomar St, Chula Vista, CA 91913-1800 | 2014-12-05 |
| 1003213141 | Michael Elyea | Pharmacist | 1400 E Palomar St, Chula Vista, CA 91913-1800 | 2014-12-03 |
| 1750798005 | Amanda Chu | Physical Therapist | 1400 E Palomar St, Chula Vista, CA 91913-1800 | 2014-07-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134774342 | Tiffany Sheffield | Physical Therapist | 1392 E Palomar Street, Suite 503, Chula Vista, CA 91913 | 2019-08-05 |
| 1710457379 | Jacqueline Rae Dagostino | Physical Therapist | 1392 E Palomar St Suite 503, Chula Vista, CA 91913 | 2018-11-27 |
| 1750806840 | Evette Pablo | Registered Nurse | 904 Saint Germain Road, Chula Vista, CA 91913 | 2017-08-09 |
| 1760912364 | Ferdinand San Jose | Registered Nurse | 1954 Marquis Court, Chula Vista, CA 91913 | 2017-06-15 |
| 1447640693 | Ian Christopher So Ignacio | Occupational Therapy Assistant | 1575 Golden Gate Ave, Chula Vista, CA 91913 | 2015-01-27 |
| 1396154274 | Helen Moreno | Dentist | 2009 Chardonnay Terrace, Chula Vista, CA 91913 | 2014-08-05 |
| 1801232236 | Edgar N Ibay | Military Health Care Provider | 1992 Caminito De La Cruz, Chula Vista, CA 91913 | 2013-05-13 |
| 1699093765 | Medical Logistics Management Inc. | Ambulance | 3130 Bonita Rd., Chula Vista, CA 91913 | 2010-05-13 |
| 1295066959 | Candice Aquino Claudio | Physical Therapist | 1400 E. Palomar, Chula Vista, CA 91913 | 2010-01-20 |
| 1417136128 | Alshafie Mohamed Hassan | Internal Medicine | 1400 East Palomar Street, Chula Vista, CA 91913 | 2007-10-30 |
| Find all providers in zip 91913 | ||||
| Taxonomy Code | 183500000X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care. |
| Notes: Source: Adapted from National Association of Boards of Pharmacy Model State Pharmacy Act, Article 1, Section 104. [1/1/2006: definition modified, source modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801417704 | Jay N Surati | Pharmacist | 2084 Otay Lakes Rd Ste 102, Chula Vista, CA 91913-1368 | 2020-05-01 |
| 1730727454 | Aimee Joy Trammell | Pharmacist | 555 Broadway Ste 1054, Chula Vista, CA 91910-5345 | 2019-12-12 |
| 1871130823 | Andrew Thak Tha Yip | Pharmacist | 1320 La Crescentia Dr, Chula Vista, CA 91910-7942 | 2019-12-09 |
| 1134777139 | Shawki Marrogi Bachoua | Pharmacist | 79 E Emerson St, Chula Vista, CA 91911-3547 | 2019-09-03 |
| 1205395597 | Victor J Wahba | Pharmacist | 1637 Third Ave Unit A, Chula Vista, CA 91911-5823 | 2019-03-15 |
| 1598221004 | Louis Valentin | Pharmacist | 480 4th Ave Ste 100, Chula Vista, CA 91910-4411 | 2019-02-20 |
| 1730695230 | Michael Edward Brown | Pharmacist | 1038 Abeto Ct, Chula Vista, CA 91910-8002 | 2017-12-19 |
| 1891209151 | Douglas Martin Faucher | Pharmacist | 384 H St # 100, Chula Vista, CA 91910-5513 | 2017-11-24 |
| 1831627207 | Hong Xuan Nguyen | Pharmacist | 1376 Third Ave, Chula Vista, CA 91911-4303 | 2017-05-30 |
| 1396270583 | Tam Trieu | Pharmacist | 555 Broaway Suite 1054, Chula Vista, CA 91910 | 2017-04-25 |
| Find all providers in CHULA VISTA | ||||
| City | CHULA VISTA |
| Zip Code | 91913 |
Please comment or provide details below to improve the information on JERALD LEE NICKELSON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.