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General NPI Number Information
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NPI Number | 1609217959
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Entity Type | Individual
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Provider Name | JACQUELINE NICOLE NICOLA PHARMD
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Gender | Female
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Dates
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Enumeration Date | 07/16/2013
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Last Update Date | 11/26/2013
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Provider Practice Location Address
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Address Line | 214 SAINT JAMES AVE
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City | GOOSE CREEK
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State | SC
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Zip | 29445-2974
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Country | US
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Telephone | 843-553-3661
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Fax |
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Provider Business Mailing Address
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Address Line | 1815 TOWNE ST
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City | JOHNS ISLAND
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State | SC
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Zip | 29455-3173
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Country | US
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Telephone | 843-446-2610
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Fax | 843-764-0305
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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 | 14238
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License Number State | SC
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