Provider Demographics
NPI:1750324265
Name:GERJETS, NICOLE MARLANE (C/RPHT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARLANE
Last Name:GERJETS
Suffix:
Gender:F
Credentials:C/RPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-6760
Mailing Address - Country:US
Mailing Address - Phone:701-250-6651
Mailing Address - Fax:
Practice Address - Street 1:900 E BISMARCK EXPY
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-6601
Practice Address - Country:US
Practice Address - Phone:701-530-6900
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND414183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician