Provider Demographics
NPI:1942623384
Name:TRASK, NICOLE M (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:M
Last Name:TRASK
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 1:333 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-7807
Mailing Address - Country:US
Mailing Address - Phone:774-455-3262
Mailing Address - Fax:
Practice Address - Street 1:333 SOUTH ST
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-7807
Practice Address - Country:US
Practice Address - Phone:774-455-3262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-21
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH234127183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist