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General NPI Number Information
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NPI Number | 1487700977
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Entity Type | Individual
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Provider Name | MISS NICOLE N PRUM
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Gender | Female
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 13424 PENNSYLVANIA AVE STE 102
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City | HAGERSTOWN
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State | MD
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Zip | 21742-2685
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Country | US
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Telephone | 240-313-3110
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Fax |
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Provider Business Mailing Address
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Address Line | 21 PLEASANT ACRES DR
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City | THURMONT
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State | MD
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Zip | 21788-1715
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 16527
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License Number State | MD
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