MEDICARE: DR. NICOLE PARKE 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	17898	NC

General Provider Information

NPI Number	:	1386966869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICOLE PARKE PHARMD

Provider Business Mailing Address
First Line	:	4625 HYLAS LANE
Second Line	:
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078
Country	:	US
Telephone Number	:	704-912-2037
Fax Number	:	704-912-2021

Provider Business Practice Location Address
First Line	:	4625 HYLAS LANE
Second Line	:
City	:	HUNTERVILLE
State	:	NC
Zip	:	28078
Country	:	US
Telephone Number	:	704-912-2037
Fax Number	:	704-912-2021

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

Provider Enumeration Date	:	02/24/2010
Last Update Date	:	11/24/2014

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