Healthcare Provider Details

I. General information

NPI: 1083170864
Provider Name (Legal Business Name): NICOLE MARY DURNIN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2019
Last Update Date: 02/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

887 STATE ROUTE 11
CHAMPLAIN NY
12919-4942
US

IV. Provider business mailing address

887 STATE ROUTE 11
CHAMPLAIN NY
12919-4942
US

V. Phone/Fax

Practice location:
  • Phone: 518-298-2975
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberI064125
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: