Healthcare Provider Details

I. General information

NPI: 1083039945
Provider Name (Legal Business Name): NICOLE MARIE OPAT PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2014
Last Update Date: 02/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 MALL BLVD
MONROEVILLE PA
15146-2230
US

IV. Provider business mailing address

4200 BOSTON CT APT 208
MONROEVILLE PA
15146-5317
US

V. Phone/Fax

Practice location:
  • Phone: 800-238-7828
  • Fax:
Mailing address:
  • Phone: 412-496-9089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP444856
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: