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NPI Code Detail

MEDICARE: MRS. MARY ELIZABETH NIKOLAI RPH

MEDICARE: MRS. MARY ELIZABETH NIKOLAI RPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist112844MN

General Provider Information

NPI Number : 1053698035
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARY ELIZABETH NIKOLAI RPH
Provider Business Mailing Address
First Line : 5825 CAHILL AVE
Second Line :
City : INVER GROVE HEIGHTS
State : MN
Zip : 55076-1515
Country : US
Telephone Number : 651-451-1503
Fax Number : 651-451-3650
Provider Business Practice Location Address
First Line : 5825 CAHILL AVE
Second Line :
City : INVER GROVE HEIGHTS
State : MN
Zip : 55076-1515
Country : US
Telephone Number : 651-451-1503
Fax Number : 651-451-3650
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/04/2011
Last Update Date : 11/04/2011

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