Provider Demographics
NPI:1598869703
Name:DURNIN, NICOLE ELIZABETH (RPH)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:ELIZABETH
Last Name:DURNIN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:ELIZABETH
Other - Last Name:DURNIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:2126 TECUMSEH RIVER ROAD
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48906
Mailing Address - Country:US
Mailing Address - Phone:517-896-1665
Mailing Address - Fax:
Practice Address - Street 1:2018 N. CEDAR STREET
Practice Address - Street 2:SUITE A
Practice Address - City:HOLT
Practice Address - State:MI
Practice Address - Zip Code:48842
Practice Address - Country:US
Practice Address - Phone:517-694-9707
Practice Address - Fax:517-694-9713
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302029280183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist