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General NPI Number Information
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NPI Number | 1386277820
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Entity Type | Individual
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Provider Name | CRISTINA MADALINA NICULAS
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Gender | Female
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Dates
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Enumeration Date | 02/12/2020
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Last Update Date | 02/12/2020
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Provider Practice Location Address
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Address Line | KROGER PHARMACY 476 6555 SUGARLOAF PARKWAY
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City | DULUTH
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State | GA
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Zip | 30097
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Country | US
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Telephone | 770-418-2398
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Fax |
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Provider Business Mailing Address
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Address Line | 6555 SUGARLOAF PKWY
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City | DULUTH
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State | GA
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Zip | 30097-4930
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Country | US
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Telephone |
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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 | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 018793
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License Number State | GA
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