Provider Demographics
NPI:1326228305
Name:PELECH, NICOLE MARIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:PELECH
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 1:94 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12803-4842
Mailing Address - Country:US
Mailing Address - Phone:518-792-5575
Mailing Address - Fax:518-747-9451
Practice Address - Street 1:94 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTH GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12803-4842
Practice Address - Country:US
Practice Address - Phone:518-792-5575
Practice Address - Fax:518-792-6415
Is Sole Proprietor?:No
Enumeration Date:2007-11-07
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051800-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist