Provider Demographics
NPI:1073378774
Name:NICOLOSI, CHRISTIAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:
Last Name:NICOLOSI
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 1:2912 S LAKE DR
Mailing Address - Street 2:
Mailing Address - City:DAVIDSONVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21035-1300
Mailing Address - Country:US
Mailing Address - Phone:443-995-0864
Mailing Address - Fax:
Practice Address - Street 1:2912 S LAKE DR
Practice Address - Street 2:
Practice Address - City:DAVIDSONVILLE
Practice Address - State:MD
Practice Address - Zip Code:21035-1300
Practice Address - Country:US
Practice Address - Phone:443-995-0864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23813183500000X
MN126392183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist