Healthcare Provider Details

I. General information

NPI: 1669148136
Provider Name (Legal Business Name): NICOLE LYNN SACERICH PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NICOLE LYNN SACERICH PHARMD

II. Dates (important events)

Enumeration Date: 08/17/2021
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

829 N WILLIAMS ST
PAULDING OH
45879-1064
US

IV. Provider business mailing address

327 N WASHINGTON ST
VAN WERT OH
45891-1258
US

V. Phone/Fax

Practice location:
  • Phone: 419-399-2010
  • Fax:
Mailing address:
  • Phone: 419-203-9944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03439033
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: