Provider Demographics
NPI:1750665154
Name:HERY, NICOLE L (PHARM D)
Entity Type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:L
Last Name:HERY
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7540 W JUDGE PEREZ DR
Mailing Address - Street 2:
Mailing Address - City:ARABI
Mailing Address - State:LA
Mailing Address - Zip Code:70032-1915
Mailing Address - Country:US
Mailing Address - Phone:504-279-0446
Mailing Address - Fax:504-278-2388
Practice Address - Street 1:7540 W JUDGE PEREZ DR
Practice Address - Street 2:
Practice Address - City:ARABI
Practice Address - State:LA
Practice Address - Zip Code:70032-1915
Practice Address - Country:US
Practice Address - Phone:504-279-0446
Practice Address - Fax:504-278-2388
Is Sole Proprietor?:No
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA019132183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA019132OtherLOUISIANA BOARD OF PHARMACY LICENSE
LA2123432Medicaid