MEDICARE: NICOLE HUMBERT PHARMD

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	1835P1400X	Pain Management Pharmacist	5302041793	MI

General Provider Information

NPI Number	:	1194689026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE HUMBERT PHARMD

Provider Business Mailing Address
First Line	:	5301 MCAULEY DR
Second Line	:
City	:	YPSILANTI
State	:	MI
Zip	:	48197-1051
Country	:	US
Telephone Number	:	734-712-6649
Fax Number	:

Provider Business Practice Location Address
First Line	:	5301 MCAULEY DR
Second Line	:
City	:	YPSILANTI
State	:	MI
Zip	:	48197-1051
Country	:	US
Telephone Number	:	734-712-6649
Fax Number	:

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

Provider Enumeration Date	:	12/15/2025
Last Update Date	:	12/15/2025

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Directions to “ NICOLE HUMBERT PHARMD” Practice Location

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