Provider Demographics
NPI:1568008555
Name:GILMORE, NICOLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:GILMORE
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 1:2513 MAPLE POINT DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-5176
Mailing Address - Country:US
Mailing Address - Phone:765-447-8337
Mailing Address - Fax:
Practice Address - Street 1:2513 MAPLE POINT DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-5176
Practice Address - Country:US
Practice Address - Phone:765-447-8337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26022820A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist