Provider Demographics
NPI:1568063014
Name:FOSSETT, NIKKI N (RPH)
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:N
Last Name:FOSSETT
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 1:4833 S PADRE ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4201
Mailing Address - Country:US
Mailing Address - Phone:361-855-7995
Mailing Address - Fax:361-855-7769
Practice Address - Street 1:4833 S PADRE ISLAND DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4201
Practice Address - Country:US
Practice Address - Phone:361-855-7995
Practice Address - Fax:361-855-7769
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25266183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist