Provider Demographics
NPI:1114200755
Name:CARDARELLI, NICOLE
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:CARDARELLI
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 1:25 PUTNAM PIKE
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-2029
Mailing Address - Country:US
Mailing Address - Phone:401-231-6561
Mailing Address - Fax:401-232-7285
Practice Address - Street 1:25 PUTNAM PIKE
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-2029
Practice Address - Country:US
Practice Address - Phone:401-231-6561
Practice Address - Fax:401-232-7285
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2011-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRPH04034183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist