Provider Demographics
NPI:1114176930
Name:FABRE-LACOSTE, NICOLE THERESA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:THERESA
Last Name:FABRE-LACOSTE
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 1:977 N CARROLLTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-3741
Mailing Address - Country:US
Mailing Address - Phone:504-486-4613
Mailing Address - Fax:504-842-5473
Practice Address - Street 1:977 N CARROLLTON AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-3741
Practice Address - Country:US
Practice Address - Phone:504-486-4613
Practice Address - Fax:504-842-5473
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA160131835P0018X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy