Provider Demographics
NPI:1558647164
Name:NACOL, AUDREY ANN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:ANN
Last Name:NACOL
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 1:705 BOYD RD
Mailing Address - Street 2:
Mailing Address - City:AZLE
Mailing Address - State:TX
Mailing Address - Zip Code:76020-4811
Mailing Address - Country:US
Mailing Address - Phone:817-444-2984
Mailing Address - Fax:
Practice Address - Street 1:705 BOYD RD
Practice Address - Street 2:
Practice Address - City:AZLE
Practice Address - State:TX
Practice Address - Zip Code:76020-4811
Practice Address - Country:US
Practice Address - Phone:817-444-2984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX49459183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist