Provider Demographics
NPI:1336820430
Name:PRENTICE, NICOLE KATHLEEN (CPHT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:KATHLEEN
Last Name:PRENTICE
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1651 E CUMBERLAND ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-8324
Mailing Address - Country:US
Mailing Address - Phone:717-270-1919
Mailing Address - Fax:
Practice Address - Street 1:728 N 2ND AVE
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17046-3017
Practice Address - Country:US
Practice Address - Phone:717-306-8512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician