Provider Demographics
NPI:1326339649
Name:INGARGIOLA, NICOLE EHRLICHER
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:EHRLICHER
Last Name:INGARGIOLA
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 1:16734 HIGHLAND CLUB AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-7023
Mailing Address - Country:US
Mailing Address - Phone:504-583-6226
Mailing Address - Fax:
Practice Address - Street 1:2152 S SHERWOOD FOREST BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-8327
Practice Address - Country:US
Practice Address - Phone:225-275-6911
Practice Address - Fax:225-274-9391
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA18815183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist