MEDICARE: MRS. NICOLE SPROUL RPH.

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	RP045927R	PA

General Provider Information

NPI Number	:	1497854202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NICOLE SPROUL RPH.

Provider Business Mailing Address
First Line	:	1304 TEDS WAY
Second Line	:
City	:	DUNCANSVILLE
State	:	PA
Zip	:	16635-7220
Country	:	US
Telephone Number	:	814-777-4888
Fax Number	:	814-641-7551

Provider Business Practice Location Address
First Line	:	730 WASHINGTON ST
Second Line	:
City	:	HUNTINGDON
State	:	PA
Zip	:	16652-1724
Country	:	US
Telephone Number	:	814-641-7442
Fax Number	:	814-641-7551

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

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	11/30/2011

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Directions to “ MRS. NICOLE SPROUL RPH.” Practice Location

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