Provider Demographics
NPI:1790048486
Name:FRIES, NICOLE M (PHARMD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:FRIES
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 1:2505 1ST ST S
Mailing Address - Street 2:T-0661
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-4215
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2505 1ST ST S
Practice Address - Street 2:T-0661
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-4215
Practice Address - Country:US
Practice Address - Phone:320-235-3026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN119734183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist