Provider Demographics
NPI:1609479559
Name:NICOLANTONIO, KATI (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KATI
Middle Name:
Last Name:NICOLANTONIO
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 1:200 RUNNING HILL RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-3258
Mailing Address - Country:US
Mailing Address - Phone:207-871-0911
Mailing Address - Fax:207-228-9861
Practice Address - Street 1:200 RUNNING HILL RD
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-3258
Practice Address - Country:US
Practice Address - Phone:207-871-0911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR12927183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist