Provider Demographics
NPI:1982985909
Name:MAIER, NICOLE LEE (PHARM D)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:LEE
Last Name:MAIER
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 W LAKE MEAD PKWY
Mailing Address - Street 2:TARGET PHARMACY STORE #2404
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-7379
Mailing Address - Country:US
Mailing Address - Phone:702-216-1901
Mailing Address - Fax:702-216-1911
Practice Address - Street 1:350 W LAKE MEAD PKWY
Practice Address - Street 2:TARGET PHARMACY STORE #2404
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-7379
Practice Address - Country:US
Practice Address - Phone:702-216-1901
Practice Address - Fax:702-216-1911
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-03
Last Update Date:2011-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV17375183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist