Provider Demographics
NPI:1710161468
Name:JAEGER, NICOLE DANIELLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:DANIELLE
Last Name:JAEGER
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 1:1101 NOTT ST # MC-1909
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12308-2425
Mailing Address - Country:US
Mailing Address - Phone:518-612-8833
Mailing Address - Fax:518-612-8873
Practice Address - Street 1:1101 NOTT ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12308-2425
Practice Address - Country:US
Practice Address - Phone:518-612-8833
Practice Address - Fax:518-612-8873
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR5042183500000X
NY49645183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist