Provider Demographics
NPI:1326644253
Name:NIECE, CAITLIN (PHARMD)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:NIECE
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 1:133 BOONE RIDGE DR APT 188
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-5025
Mailing Address - Country:US
Mailing Address - Phone:276-455-9889
Mailing Address - Fax:
Practice Address - Street 1:4307 N ROAN ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37615-5036
Practice Address - Country:US
Practice Address - Phone:423-952-0088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN43293183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist