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NPI Code Detail

MEDICARE: NICOLE KAMSTRA

MEDICARE:   NICOLE  KAMSTRA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist03-1-24700OH

General Provider Information

NPI Number : 1003938432
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE KAMSTRA
Provider Business Mailing Address
First Line : 225 NEWPINE DR
Second Line :
City : CLEVES
State : OH
Zip : 45002-2384
Country : US
Telephone Number : 513-941-2531
Fax Number :
Provider Business Practice Location Address
First Line : 5053 GLENWAY AVE
Second Line :
City : CINCINNATI
State : OH
Zip : 45238-3903
Country : US
Telephone Number : 513-471-7575
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/05/2007
Last Update Date : 07/08/2007

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Directions to “ NICOLE KAMSTRA ” Practice Location

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