Provider Demographics
NPI:1740629823
Name:BARNETT, NICOLE RAE (PHARMD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:RAE
Last Name:BARNETT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-1921
Mailing Address - Country:US
Mailing Address - Phone:320-219-2860
Mailing Address - Fax:218-631-2726
Practice Address - Street 1:321 JEFFERSON ST N
Practice Address - Street 2:
Practice Address - City:WADENA
Practice Address - State:MN
Practice Address - Zip Code:56482-1372
Practice Address - Country:US
Practice Address - Phone:218-631-4050
Practice Address - Fax:218-631-2726
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-21
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN120403183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist