Provider Demographics
NPI:1457644569
Name:METZINGER, NICHOLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:METZINGER
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 1:100 E SIOUX AVE
Mailing Address - Street 2:
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501-3196
Mailing Address - Country:US
Mailing Address - Phone:605-224-4962
Mailing Address - Fax:605-945-0062
Practice Address - Street 1:100 E SIOUX AVE
Practice Address - Street 2:
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501-3196
Practice Address - Country:US
Practice Address - Phone:605-224-4962
Practice Address - Fax:605-945-0062
Is Sole Proprietor?:No
Enumeration Date:2011-05-23
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD5237183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist