MEDICARE: NICOLE VACCARI

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	21867	MA

General Provider Information

NPI Number	:	1245835255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE VACCARI

Provider Business Mailing Address
First Line	:	15 BLUEBERRY LN
Second Line	:
City	:	N DARTMOUTH
State	:	MA
Zip	:	02747-1580
Country	:	US
Telephone Number	:	508-272-4659
Fax Number	:

Provider Business Practice Location Address
First Line	:	548 DARTMOUTH ST
Second Line	:
City	:	DARTMOUTH
State	:	MA
Zip	:	02748-1908
Country	:	US
Telephone Number	:	508-991-7934
Fax Number	:

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

Provider Enumeration Date	:	11/30/2020
Last Update Date	:	11/30/2020

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Directions to “ NICOLE VACCARI ” Practice Location

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