Provider Demographics
NPI:1073882577
Name:COATES, NICOLAS (PHARMD)
Entity Type:Individual
Prefix:
First Name:NICOLAS
Middle Name:
Last Name:COATES
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9040 W GOOD HOPE RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53224-4112
Mailing Address - Country:US
Mailing Address - Phone:414-358-1526
Mailing Address - Fax:414-358-1745
Practice Address - Street 1:9040 W GOOD HOPE RD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53224-4112
Practice Address - Country:US
Practice Address - Phone:414-358-1526
Practice Address - Fax:414-358-1745
Is Sole Proprietor?:No
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14494-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist