MEDICARE: NICOLE MARIE SCHENK 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
1	183500000X	Pharmacist	014074	AZ

General Provider Information

NPI Number	:	1790033827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE MARIE SCHENK RPH

Provider Business Mailing Address
First Line	:	16413 S 29TH DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85045-2282
Country	:	US
Telephone Number	:	480-704-1340
Fax Number	:

Provider Business Practice Location Address
First Line	:	4121 E COTTON CENTER BLVD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85040-8849
Country	:	US
Telephone Number	:	602-431-4004
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2012
Last Update Date	:	08/21/2012

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