Provider Demographics
NPI:1376149450
Name:SCORE, NANCY RENEE
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:RENEE
Last Name:SCORE
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 1:500 E GRANT ST APT 1707
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-1476
Mailing Address - Country:US
Mailing Address - Phone:612-202-6122
Mailing Address - Fax:
Practice Address - Street 1:17756 KENWOOD TRL
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-9454
Practice Address - Country:US
Practice Address - Phone:952-435-0542
Practice Address - Fax:952-435-2072
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-05
Last Update Date:2020-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN113981183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty