Provider Demographics
NPI:1669077756
Name:PROMISE, NICOLE (RPH)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:PROMISE
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 1:15731 SWEETWATER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-1653
Mailing Address - Country:US
Mailing Address - Phone:832-504-8068
Mailing Address - Fax:
Practice Address - Street 1:31013 FM 2920 RD
Practice Address - Street 2:
Practice Address - City:WALLER
Practice Address - State:TX
Practice Address - Zip Code:77484-8008
Practice Address - Country:US
Practice Address - Phone:936-372-9141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX55132183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist