Provider Demographics
NPI:1508460718
Name:CAIN, NIKOLE (RPH)
Entity Type:Individual
Prefix:
First Name:NIKOLE
Middle Name:
Last Name:CAIN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6364 W STATE ROAD 14
Mailing Address - Street 2:
Mailing Address - City:RENSSELAER
Mailing Address - State:IN
Mailing Address - Zip Code:47978-7416
Mailing Address - Country:US
Mailing Address - Phone:219-869-5723
Mailing Address - Fax:
Practice Address - Street 1:310 N HALLECK ST
Practice Address - Street 2:
Practice Address - City:DEMOTTE
Practice Address - State:IN
Practice Address - Zip Code:46310-9419
Practice Address - Country:US
Practice Address - Phone:219-987-3301
Practice Address - Fax:219-987-3353
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-28
Last Update Date:2020-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26019271A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist