=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144661190
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MS. NICHOLE MICHELLE MEALEY
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2013
-----------------------------------------------------
Last Update Date | 07/07/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 301 ROSS AVE APARTMENT 4
-----------------------------------------------------
City | NEW CUMBERLAND
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17070-2605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-991-6920
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 301 ROSS AVE APARTMENT 4
-----------------------------------------------------
City | NEW CUMBERLAND
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17070-2605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-991-6920
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183700000X
-----------------------------------------------------
Taxonomy Name | Pharmacy Technician
-----------------------------------------------------
License Number | 10004627
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------