Provider Demographics
NPI:1508045360
Name:DARBYSHIRE, NICOLE N
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:N
Last Name:DARBYSHIRE
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 1:2025 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-5021
Mailing Address - Country:US
Mailing Address - Phone:518-456-5112
Mailing Address - Fax:518-869-7214
Practice Address - Street 1:2025 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-5021
Practice Address - Country:US
Practice Address - Phone:518-456-5112
Practice Address - Fax:518-869-7214
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-29
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20-049177183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist