Healthcare Provider Details

I. General information

NPI: 1992666895
Provider Name (Legal Business Name): NICOLE PARADIS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2025
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 BRANTWOOD DR
ELKTON MD
21921-8348
US

IV. Provider business mailing address

700 MULLICA HILL RD
MULLICA HILL NJ
08062-4413
US

V. Phone/Fax

Practice location:
  • Phone: 410-920-6229
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI04471100
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: