Healthcare Provider Details

I. General information

NPI: 1205277613
Provider Name (Legal Business Name): NICOLE WURM PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2013
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 GOUGLER AVE
KENT OH
44240-2401
US

IV. Provider business mailing address

1400 S ARLINGTON ST UNIT 38 PO BOX 7695
AKRON OH
44306-3771
US

V. Phone/Fax

Practice location:
  • Phone: 888-975-9188
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03232628-2
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number03232628-2
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: