Provider Demographics
NPI:1396367801
Name:URICK, NICOLE HAZARA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:HAZARA
Last Name:URICK
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 1:12604 PEMBROOKE CIR
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-8341
Mailing Address - Country:US
Mailing Address - Phone:317-679-3049
Mailing Address - Fax:
Practice Address - Street 1:12604 PEMBROOKE CIR
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-8341
Practice Address - Country:US
Practice Address - Phone:317-679-3049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-07
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26021131A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist