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NPI Code Detail

MEDICARE: NANCY LEE NICOLSKI

MEDICARE: NANCY LEE NICOLSKI
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
1183500000XPharmacist0202206502VA

General Provider Information

NPI Number : 1386926343
Entity Type Code : Individual
Provider Name (Legal Business Name) : NANCY LEE NICOLSKI
Provider Business Mailing Address
First Line : 4106 PORTSMOUTH BLVD
Second Line :
City : PORTSMOUTH
State : VA
Zip : 23701-2968
Country : US
Telephone Number : 757-391-2850
Fax Number : 757-391-0213
Provider Business Practice Location Address
First Line : 4106 PORTSMOUTH BLVD
Second Line :
City : PORTSMOUTH
State : VA
Zip : 23701-2968
Country : US
Telephone Number : 757-391-2850
Fax Number : 757-391-0213
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/15/2011
Last Update Date : 09/15/2011

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Directions to “ NANCY LEE NICOLSKI ” Practice Location

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