Provider Demographics
NPI:1437605276
Name:NEVILLE, NICHOLE RAE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLE
Middle Name:RAE
Last Name:NEVILLE
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 1:11842 E 116TH DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:CO
Mailing Address - Zip Code:80640-7632
Mailing Address - Country:US
Mailing Address - Phone:970-520-9033
Mailing Address - Fax:
Practice Address - Street 1:12505 E 16TH AVE
Practice Address - Street 2:MAIL STOP F757
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045
Practice Address - Country:US
Practice Address - Phone:720-848-5340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY018562183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist