Healthcare Provider Details

I. General information

NPI: 1245835255
Provider Name (Legal Business Name): NICOLE VACCARI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2020
Last Update Date: 11/30/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

548 DARTMOUTH ST
DARTMOUTH MA
02748-1908
US

IV. Provider business mailing address

15 BLUEBERRY LN
N DARTMOUTH MA
02747-1580
US

V. Phone/Fax

Practice location:
  • Phone: 508-991-7934
  • Fax:
Mailing address:
  • Phone: 508-272-4659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number21867
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: