Provider Demographics
NPI:1881864817
Name:BELLAND, NICHOLE TANYA (PHARMD)
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:TANYA
Last Name:BELLAND
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 1:691 E EMPIRE ST # 81321
Mailing Address - Street 2:
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-2802
Mailing Address - Country:US
Mailing Address - Phone:970-565-7946
Mailing Address - Fax:
Practice Address - Street 1:691 E EMPIRE ST # 81321
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-2802
Practice Address - Country:US
Practice Address - Phone:970-565-7946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-05
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15063183500000X
CO0018697183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0018697OtherCO LICENSE
WI15063OtherWI LICENSE