Provider Demographics
NPI:1356627566
Name:MONTAGUE, NIKKI DAWN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NIKKI
Middle Name:DAWN
Last Name:MONTAGUE
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 1:3842 BALMORAL DR
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-8117
Mailing Address - Country:US
Mailing Address - Phone:815-325-8591
Mailing Address - Fax:
Practice Address - Street 1:302 E UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61802-2500
Practice Address - Country:US
Practice Address - Phone:217-344-7201
Practice Address - Fax:217-344-7290
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-290823183500000X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy