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General NPI Number Information
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NPI Number | 1639752744
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Entity Type | Individual
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Provider Name | NICOLE ANNE LUCIBELLO
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Gender | Female
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Dates
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Enumeration Date | 05/05/2021
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Last Update Date | 05/05/2021
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Provider Practice Location Address
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Address Line | 10 FAIRFIELD BLVD UNIT C2
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City | WALLINGFORD
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State | CT
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Zip | 06492-5903
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Country | US
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Telephone | 203-969-4404
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Fax | 203-815-1661
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Provider Business Mailing Address
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Address Line | 7 CARLEN DR
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City | NORTHFORD
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State | CT
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Zip | 06472-1607
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Country | US
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Telephone | 203-889-7605
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Fax | 203-815-1661
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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 | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | PTN0004329
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License Number State | CT
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