Provider Demographics
NPI:1710257555
Name:COVERT, NICOLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:COVERT
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:PRIME THERAPEUTICS
Mailing Address - Street 2:8400 NORMANDALE LAKE BOULEVARD, 6-221
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55437-4233
Mailing Address - Country:US
Mailing Address - Phone:612-777-1509
Mailing Address - Fax:
Practice Address - Street 1:1511 HIGHWAY 7
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55305-4739
Practice Address - Country:US
Practice Address - Phone:952-939-1917
Practice Address - Fax:952-939-1881
Is Sole Proprietor?:No
Enumeration Date:2012-01-11
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN116998-21835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy