Provider Demographics
NPI:1083201057
Name:PRYOR, NICOLE JEWEL
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:JEWEL
Last Name:PRYOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 MERRIMAC TRL
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-5351
Mailing Address - Country:US
Mailing Address - Phone:757-258-4450
Mailing Address - Fax:757-258-5574
Practice Address - Street 1:700 MERRIMAC TRL
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-5351
Practice Address - Country:US
Practice Address - Phone:757-258-4450
Practice Address - Fax:757-258-5574
Is Sole Proprietor?:No
Enumeration Date:2020-12-24
Last Update Date:2020-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202211391183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist