Healthcare Provider Details

I. General information

NPI: 1659029536
Provider Name (Legal Business Name): NICOLE ELIZABETH O'TOOLE PHARMD, RPH, MTM-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2022
Last Update Date: 04/15/2023
Certification Date: 04/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 MULLICA HILL RD
MULLICA HILL NJ
08062-4413
US

IV. Provider business mailing address

619 ANDERSON AVE
HAMMONTON NJ
08037-3175
US

V. Phone/Fax

Practice location:
  • Phone: 856-508-1000
  • Fax:
Mailing address:
  • Phone: 609-464-1855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number28RI04218500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: