Provider Demographics
NPI:1205147048
Name:THIELET, NIKKI LYNN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:NIKKI
Middle Name:LYNN
Last Name:THIELET
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 1:623 SAINT CLAIR AVE
Mailing Address - Street 2:
Mailing Address - City:CLAIRTON
Mailing Address - State:PA
Mailing Address - Zip Code:15025-1436
Mailing Address - Country:US
Mailing Address - Phone:412-233-2703
Mailing Address - Fax:412-233-5382
Practice Address - Street 1:623 SAINT CLAIR AVE
Practice Address - Street 2:
Practice Address - City:CLAIRTON
Practice Address - State:PA
Practice Address - Zip Code:15025-1436
Practice Address - Country:US
Practice Address - Phone:412-233-2703
Practice Address - Fax:412-233-5382
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-26
Last Update Date:2010-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP045527L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP045527LOtherSTATE LICENSE
PARPI000055OtherSTATE AUTHORIZATION TO ADMINISTER INJECTABLES