Provider Demographics
NPI:1043644594
Name:LANDIS, NICOLE C (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:C
Last Name:LANDIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3732 DARROW RD
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-4050
Mailing Address - Country:US
Mailing Address - Phone:330-686-5285
Mailing Address - Fax:
Practice Address - Street 1:3732 DARROW RD
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-4050
Practice Address - Country:US
Practice Address - Phone:330-686-5285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-02
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY016767183500000X
OH03232763183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist