Healthcare Provider Details

I. General information

NPI: 1104933936
Provider Name (Legal Business Name): NICOLE D ALLIE PHARMD, CGP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 05/22/2020
Certification Date: 05/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

485 ARSENAL ST HVMA PHARMACY ADMINISTRATION
WATERTOWN MA
02472-5091
US

IV. Provider business mailing address

25 WILDWOOD RD
PEMBROKE MA
02359-2535
US

V. Phone/Fax

Practice location:
  • Phone: 617-972-5329
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number26201
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: