Provider Demographics
NPI:1710582648
Name:SALES, NICOLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:SALES
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 1:1277 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:BEECHER
Mailing Address - State:IL
Mailing Address - Zip Code:60401-4040
Mailing Address - Country:US
Mailing Address - Phone:708-946-3714
Mailing Address - Fax:
Practice Address - Street 1:1277 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:BEECHER
Practice Address - State:IL
Practice Address - Zip Code:60401-4040
Practice Address - Country:US
Practice Address - Phone:708-946-3714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.294099183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist