MEDICARE: MS. MELANIE ANNE NICOLAY 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	183500000X	Pharmacist	PST.021611	LA
2	183500000X	Pharmacist	E14602	MS

General Provider Information

NPI Number	:	1356895437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MELANIE ANNE NICOLAY PHARMD

Provider Business Mailing Address
First Line	:	2119 SYLVIA BLVD
Second Line	:
City	:	SAINT BERNARD
State	:	LA
Zip	:	70085-5148
Country	:	US
Telephone Number	:	504-554-3535
Fax Number	:

Provider Business Practice Location Address
First Line	:	2119 SYLVIA BLVD
Second Line	:
City	:	SAINT BERNARD
State	:	LA
Zip	:	70085-5148
Country	:	US
Telephone Number	:	504-554-3535
Fax Number	:

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

Provider Enumeration Date	:	08/07/2016
Last Update Date	:	08/07/2016

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