Provider Demographics
NPI:1689279788
Name:PIQUETTE, NICOLE BETTY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:BETTY
Last Name:PIQUETTE
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 1:84 LAKEVIEW ACRES DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON LAKE
Mailing Address - State:NE
Mailing Address - Zip Code:68937
Mailing Address - Country:US
Mailing Address - Phone:262-832-4541
Mailing Address - Fax:
Practice Address - Street 1:102 E PHILIP AVE
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-5537
Practice Address - Country:US
Practice Address - Phone:308-532-4303
Practice Address - Fax:308-532-4628
Is Sole Proprietor?:No
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE16947183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE16947OtherRPH LICENSE
OH03439645OtherRPH LICENSE