Provider Demographics
NPI:1972059145
Name:HART, NICHOLE (PHARM D)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:HART
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 BAY LN
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02632-3314
Mailing Address - Country:US
Mailing Address - Phone:585-409-5128
Mailing Address - Fax:
Practice Address - Street 1:3848 FALMOUTH RD
Practice Address - Street 2:
Practice Address - City:MARSTONS MILLS
Practice Address - State:MA
Practice Address - Zip Code:02648-5707
Practice Address - Country:US
Practice Address - Phone:508-428-3525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH236919183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist