Provider Demographics
NPI:1225552987
Name:HOUSTON, NICOLE FISETTE (RPH)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:FISETTE
Last Name:HOUSTON
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 1:14625 FM 529 RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-3509
Mailing Address - Country:US
Mailing Address - Phone:281-463-9088
Mailing Address - Fax:
Practice Address - Street 1:14625 FM 529 RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-3509
Practice Address - Country:US
Practice Address - Phone:281-463-9088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-02
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62414183500000X
LA022090183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist