Provider Demographics
NPI:1669606984
Name:CLAUSEN, NICOLE MARIE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:MARIE
Last Name:CLAUSEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:NICOLE
Other - Middle Name:MARIE
Other - Last Name:LOFHOLM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1525 FRANCISCO BLVD E STE 2
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-5560
Mailing Address - Country:US
Mailing Address - Phone:415-455-9042
Mailing Address - Fax:415-455-9318
Practice Address - Street 1:1525 FRANCISCO BLVD E STE 2
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-5560
Practice Address - Country:US
Practice Address - Phone:415-455-9042
Practice Address - Fax:415-455-9318
Is Sole Proprietor?:No
Enumeration Date:2009-05-14
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60056183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist