Provider Demographics
NPI:1942594213
Name:MUSFELT, NICOLE M
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:M
Last Name:MUSFELT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 EGLIN ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-9504
Mailing Address - Country:US
Mailing Address - Phone:605-342-8621
Mailing Address - Fax:
Practice Address - Street 1:1415 EGLIN ST
Practice Address - Street 2:TARGET 2457
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-9504
Practice Address - Country:US
Practice Address - Phone:065-341-8621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-04
Last Update Date:2011-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR5595183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist