Provider Demographics
NPI:1356012397
Name:MUNOZ, NICOLE (RPH)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:MUNOZ
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 1:2100 ROUTE 70 W
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-2772
Mailing Address - Country:US
Mailing Address - Phone:856-488-2745
Mailing Address - Fax:856-488-2798
Practice Address - Street 1:2100 ROUTE 70 W
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-2772
Practice Address - Country:US
Practice Address - Phone:856-488-2745
Practice Address - Fax:856-488-2798
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02636600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist