Healthcare Provider Details

I. General information

NPI: 1164663456
Provider Name (Legal Business Name): NICOLE L CHOPSKI PHARMD, CGP, ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2009
Last Update Date: 03/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 HOSPITAL WAY ATTN: PHARMACY
POCATELLO ID
83201-2708
US

IV. Provider business mailing address

PO BOX 3005
POCATELLO ID
83206-3005
US

V. Phone/Fax

Practice location:
  • Phone: 208-339-0420
  • Fax:
Mailing address:
  • Phone: 208-339-0420
  • Fax: 208-233-6769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License NumberP5247
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code1835N0905X
TaxonomyNuclear Pharmacist
License NumberP5247
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: