Provider Demographics
NPI:1457326605
Name:CONN, NICOLE MILLER (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:MILLER
Last Name:CONN
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 1:10277 LAKE LILLEY RD
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE
Mailing Address - State:MS
Mailing Address - Zip Code:39756-9727
Mailing Address - Country:US
Mailing Address - Phone:662-369-8164
Mailing Address - Fax:
Practice Address - Street 1:10277 LAKE LILLEY RD
Practice Address - Street 2:
Practice Address - City:PRAIRIE
Practice Address - State:MS
Practice Address - Zip Code:39756-9727
Practice Address - Country:US
Practice Address - Phone:662-369-8164
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-09047183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist