Provider Demographics
NPI:1659972487
Name:LLOYD, NICOLE LEIGH
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:LEIGH
Last Name:LLOYD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 E MARKET ST APT 9
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-2550
Mailing Address - Country:US
Mailing Address - Phone:970-368-0340
Mailing Address - Fax:
Practice Address - Street 1:614 CROSSINGS RD
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-8909
Practice Address - Country:US
Practice Address - Phone:419-626-1820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03124802183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist