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General NPI Number Information
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NPI Number | 1669148136
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Entity Type | Individual
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Provider Name | NICOLE LYNN LOSH PHARMD
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Gender | Female
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Dates
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Enumeration Date | 08/17/2021
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Last Update Date | 07/18/2023
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Provider Practice Location Address
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Address Line | 3801 COLDWATER RD
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City | FORT WAYNE
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State | IN
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Zip | 46805-1101
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Country | US
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Telephone | 260-470-6361
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Fax | 260-470-6371
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Provider Business Mailing Address
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Address Line | 327 N WASHINGTON ST
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City | VAN WERT
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State | OH
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Zip | 45891-1258
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Country | US
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Telephone | 419-203-9944
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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 | 26028368A
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License Number State | IN
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