Provider Demographics
NPI:1922771542
Name:ROESLER, NIKOLE LOREN (PHARMD)
Entity Type:Individual
Prefix:
First Name:NIKOLE
Middle Name:LOREN
Last Name:ROESLER
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 1:1114A CHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37206-2222
Mailing Address - Country:US
Mailing Address - Phone:502-648-2196
Mailing Address - Fax:
Practice Address - Street 1:198 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-2520
Practice Address - Country:US
Practice Address - Phone:615-264-3583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN45419183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN45419OtherPHARMACIST