Healthcare Provider Details

I. General information

NPI: 1649868555
Provider Name (Legal Business Name): NICHOLE JENNINGS ALLEN PHAMD, CPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2021
Last Update Date: 01/06/2021
Certification Date: 01/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 STANTONSBURG RD
GREENVILLE NC
27834-2818
US

IV. Provider business mailing address

1033 BRANCH RD
WINTERVILLE NC
28590-8842
US

V. Phone/Fax

Practice location:
  • Phone: 252-847-4481
  • Fax: 252-847-8061
Mailing address:
  • Phone: 252-916-6843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number700278
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: