Healthcare Provider Details

I. General information

NPI: 1235370123
Provider Name (Legal Business Name): NICOLE ANN HUBACH R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2009
Last Update Date: 03/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26851 MILES RD STE 202
WARRENSVILLE HEIGHTS OH
44128-5991
US

IV. Provider business mailing address

26851 MILES ROAD SUITE 202
WARRENSVILLE HEIGHTS OH
44128
US

V. Phone/Fax

Practice location:
  • Phone: 216-292-2999
  • Fax: 216-292-2992
Mailing address:
  • Phone: 216-292-2999
  • Fax: 216-292-2992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03-3-21640
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13083
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number013926K
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number18383
License Number StateLA
# 5
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD10629
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: