Provider Demographics
NPI:1841404597
Name:NICOLL, JILL F (RPH)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:F
Last Name:NICOLL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 FAIRFIELD DR
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-1054
Mailing Address - Country:US
Mailing Address - Phone:985-727-4712
Mailing Address - Fax:
Practice Address - Street 1:2045 HIGHWAY 59
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-1909
Practice Address - Country:US
Practice Address - Phone:985-626-9726
Practice Address - Fax:985-626-7919
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15174183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist