Provider Demographics
NPI:1679184436
Name:NANCE, ALISON NICOLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:NICOLE
Last Name:NANCE
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 1:1955 S NATIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2214
Mailing Address - Country:US
Mailing Address - Phone:417-881-6836
Mailing Address - Fax:417-877-1746
Practice Address - Street 1:1955 S NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2214
Practice Address - Country:US
Practice Address - Phone:417-881-6836
Practice Address - Fax:417-877-1746
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019024428183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist