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General NPI Number Information
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NPI Number | 1366326852
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Entity Type | Individual
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Provider Name | ALEXIS ROSE NICOSON PHARMD
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Gender | Female
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Dates
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Enumeration Date | 08/05/2025
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Last Update Date | 08/05/2025
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Provider Practice Location Address
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Address Line | 7301 LAKE SHORE BLVD
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City | MENTOR
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State | OH
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Zip | 44060-3029
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Country | US
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Telephone | 440-602-6071
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Fax |
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Provider Business Mailing Address
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Address Line | 804 MEADOWOOD BLVD
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City | MADISON
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State | OH
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Zip | 44057-2914
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Country | US
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Telephone | 440-321-9956
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 03445807
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License Number State | OH
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