Provider Demographics
NPI:1710398078
Name:SCALZO, NICHOLE VENA
Entity Type:Individual
Prefix:MRS
First Name:NICHOLE
Middle Name:VENA
Last Name:SCALZO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6088 VIEWPOINT DR NE
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MI
Mailing Address - Zip Code:49306-8916
Mailing Address - Country:US
Mailing Address - Phone:616-481-5432
Mailing Address - Fax:616-863-3465
Practice Address - Street 1:2799 10 MILE RD NE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-9100
Practice Address - Country:US
Practice Address - Phone:616-863-3433
Practice Address - Fax:616-863-3465
Is Sole Proprietor?:No
Enumeration Date:2014-05-08
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020289501835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy