Provider Demographics
NPI:1356126783
Name:LACOFF, NICOLE SHARIE (RPH)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:SHARIE
Last Name:LACOFF
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:SHARIE
Other - Last Name:BOYLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:536 THAD ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43609-1522
Mailing Address - Country:US
Mailing Address - Phone:313-310-2710
Mailing Address - Fax:
Practice Address - Street 1:5225 MONROE ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3139
Practice Address - Country:US
Practice Address - Phone:419-843-1622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03443597183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist