MEDICARE: NICOLE MORTEL

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	60690	SC

General Provider Information

NPI Number	:	1750215885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE MORTEL

Provider Business Mailing Address
First Line	:	1228 PINERIDGE ST
Second Line	:
City	:	CONWAY
State	:	SC
Zip	:	29527-6066
Country	:	US
Telephone Number	:	843-957-1103
Fax Number	:

Provider Business Practice Location Address
First Line	:	5001 SOCASTEE BLVD
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-7339
Country	:	US
Telephone Number	:	843-293-6066
Fax Number	:

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

Provider Enumeration Date	:	06/12/2026
Last Update Date	:	06/12/2026

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Directions to “ NICOLE MORTEL ” Practice Location

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