Provider Demographics
NPI:1174846851
Name:STINNETT, NICHOLE BEAM (RPH)
Entity Type:Individual
Prefix:MRS
First Name:NICHOLE
Middle Name:BEAM
Last Name:STINNETT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:438 CHESTNUT RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:KINGS MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28086-8114
Mailing Address - Country:US
Mailing Address - Phone:704-739-3569
Mailing Address - Fax:
Practice Address - Street 1:438 CHESTNUT RIDGE RD
Practice Address - Street 2:
Practice Address - City:KINGS MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28086-8114
Practice Address - Country:US
Practice Address - Phone:704-739-3569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14231183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist