MEDICARE: DR. AUDREY ANN NACOL PHARM.D.

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	49459	TX

General Provider Information

NPI Number	:	1558647164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AUDREY ANN NACOL PHARM.D.

Provider Business Mailing Address
First Line	:	705 BOYD RD
Second Line	:
City	:	AZLE
State	:	TX
Zip	:	76020-4811
Country	:	US
Telephone Number	:	817-444-2984
Fax Number	:

Provider Business Practice Location Address
First Line	:	705 BOYD RD
Second Line	:
City	:	AZLE
State	:	TX
Zip	:	76020-4811
Country	:	US
Telephone Number	:	817-444-2984
Fax Number	:

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

Provider Enumeration Date	:	10/26/2011
Last Update Date	:	10/26/2011

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