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General NPI Number Information
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NPI Number | 1508402751
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Entity Type | Individual
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Provider Name | SUSAN L NIKOLAI RPH
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Gender | Female
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Dates
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Enumeration Date | 11/22/2019
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Last Update Date | 11/22/2019
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Provider Practice Location Address
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Address Line | 34 S BROWN ST
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City | RHINELANDER
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State | WI
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Zip | 54501-3449
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Country | US
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Telephone | 715-420-1685
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Fax | 715-420-1373
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Provider Business Mailing Address
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Address Line | 2720 APPLE LN
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City | RHINELANDER
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State | WI
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Zip | 54501-9470
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Country | US
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Telephone | 715-550-1440
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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 | 10839-40
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License Number State | WI
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