Provider Demographics
NPI:1437321254
Name:ESCHER, NICOLE MARIE
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:ESCHER
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 1:1380 SHOW CT
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45434-5651
Mailing Address - Country:US
Mailing Address - Phone:419-277-1410
Mailing Address - Fax:
Practice Address - Street 1:707 S EDWIN C MOSES BLVD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-3462
Practice Address - Country:US
Practice Address - Phone:419-277-1410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-01
Last Update Date:2016-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH06005027183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist