Provider Demographics
NPI:1538503230
Name:FLYNN, NICOLE A (PHARMD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:A
Last Name:FLYNN
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 1:240 W BASELINE RD
Mailing Address - Street 2:PHARMACY 3799
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-6107
Mailing Address - Country:US
Mailing Address - Phone:480-668-9512
Mailing Address - Fax:480-668-9514
Practice Address - Street 1:240 W BASELINE RD
Practice Address - Street 2:PHARMACY 3799
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-6107
Practice Address - Country:US
Practice Address - Phone:480-668-9512
Practice Address - Fax:480-668-9514
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-24
Last Update Date:2016-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS018922183500000X
MEPR5105183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist