Provider Demographics
NPI:1235370123
Name:HUBACH, NICOLE ANN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:ANN
Last Name:HUBACH
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 1:26851 MILES ROAD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WARRENSVILLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44128
Mailing Address - Country:US
Mailing Address - Phone:216-292-2999
Mailing Address - Fax:216-292-2992
Practice Address - Street 1:26851 MILES RD STE 202
Practice Address - Street 2:
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44128-5991
Practice Address - Country:US
Practice Address - Phone:216-292-2999
Practice Address - Fax:216-292-2992
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-23
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-21640183500000X
NE13083183500000X
KY013926K183500000X
LA18383183500000X
ARPD10629183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist