Healthcare Provider Details

I. General information

NPI: 1982298931
Provider Name (Legal Business Name): NICOLE CHRISTINE BECKER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2021
Last Update Date: 06/18/2022
Certification Date: 04/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2348 ROUTE 19 N
WARSAW NY
14569-9356
US

IV. Provider business mailing address

100 ALBERT DR
LANCASTER NY
14086-2804
US

V. Phone/Fax

Practice location:
  • Phone: 585-786-0880
  • Fax:
Mailing address:
  • Phone: 716-225-8552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number067411
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: