Provider Demographics
NPI:1689283301
Name:BARBER, NICOLE ALYSSA (PHARMD, BSPS)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ALYSSA
Last Name:BARBER
Suffix:
Gender:F
Credentials:PHARMD, BSPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 HEATHERWILDE BLVD APT 1134
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-4572
Mailing Address - Country:US
Mailing Address - Phone:570-578-0537
Mailing Address - Fax:
Practice Address - Street 1:3921 W PARMER LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78727-4121
Practice Address - Country:US
Practice Address - Phone:512-832-1092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66943183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist