Provider Demographics
NPI:1972633717
Name:SEREDAY, NICOLLE THERESA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:NICOLLE
Middle Name:THERESA
Last Name:SEREDAY
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:PO BOX 768
Mailing Address - Street 2:
Mailing Address - City:WHITE SULPHUR SPRINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59645-0768
Mailing Address - Country:US
Mailing Address - Phone:406-547-2412
Mailing Address - Fax:406-547-2162
Practice Address - Street 1:4271 US HIGHWAY 12 E
Practice Address - Street 2:
Practice Address - City:WHITE SULPHUR SPRINGS
Practice Address - State:MT
Practice Address - Zip Code:59645-9630
Practice Address - Country:US
Practice Address - Phone:406-547-2316
Practice Address - Fax:406-547-2162
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4562183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist