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General NPI Number Information
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NPI Number | 1396956843
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Entity Type | Individual
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Provider Name | NICOLE MARIE MISTICHELLI RPH
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Gender | Female
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Dates
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Enumeration Date | 05/25/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 10 CHURCH ST
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City | LITTLE SILVER
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State | NJ
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Zip | 07739-1440
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Country | US
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Telephone | 732-741-1121
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Fax | 732-224-0107
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Provider Business Mailing Address
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Address Line | 63 BROADWAY RD
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City | WARREN
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State | NJ
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Zip | 07059-5001
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Country | US
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Telephone | 908-350-3598
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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 | 28RI02615300
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License Number State | NJ
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