Provider Demographics
NPI:1336461086
Name:MONTANARO, NICOLE MARIE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:MARIE
Last Name:MONTANARO
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 1:8064 BREWERTON RD
Mailing Address - Street 2:WALMART PHARMACY
Mailing Address - City:CICERO
Mailing Address - State:NY
Mailing Address - Zip Code:13039-9584
Mailing Address - Country:US
Mailing Address - Phone:315-698-0105
Mailing Address - Fax:315-698-0403
Practice Address - Street 1:8064 BREWERTON RD
Practice Address - Street 2:WALMART PHARMACY
Practice Address - City:CICERO
Practice Address - State:NY
Practice Address - Zip Code:13039-9584
Practice Address - Country:US
Practice Address - Phone:315-698-0105
Practice Address - Fax:315-698-0403
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052597-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist