Healthcare Provider Details

I. General information

NPI: 1639658909
Provider Name (Legal Business Name): NICOLE MARIE BURLINE PHARMD, RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2018
Last Update Date: 08/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4854 COMMERCIAL DR
NEW HARTFORD NY
13413-6206
US

IV. Provider business mailing address

388 HACADAM RD
SAUQUOIT NY
13456-3513
US

V. Phone/Fax

Practice location:
  • Phone: 315-736-5232
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberI064201-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: