Provider Demographics
NPI:1295125847
Name:PILIC, NICOL (PHARM D)
Entity type:Individual
Prefix:DR
First Name:NICOL
Middle Name:
Last Name:PILIC
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 1:515 HANOVER AVE
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-2017
Mailing Address - Country:US
Mailing Address - Phone:856-220-0253
Mailing Address - Fax:
Practice Address - Street 1:79 JONQUIL WAY
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-4104
Practice Address - Country:US
Practice Address - Phone:856-220-0253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-03
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03866500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist