MEDICARE: NICOLE A PROSKE RPH

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
1	183500000X	Pharmacist	RP039160L	PA

General Provider Information

NPI Number	:	1093701906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE A PROSKE RPH

Provider Business Mailing Address
First Line	:	190 N FRALEY ST
Second Line	:
City	:	KANE
State	:	PA
Zip	:	16735-1165
Country	:	US
Telephone Number	:	814-837-8500
Fax Number	:

Provider Business Practice Location Address
First Line	:	190 N FRALEY ST
Second Line	:
City	:	KANE
State	:	PA
Zip	:	16735-1165
Country	:	US
Telephone Number	:	814-837-8500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2005
Last Update Date	:	01/09/2011

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Directions to “ NICOLE A PROSKE RPH” Practice Location

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