MEDICARE: MRS. NICOLE M MUSFELT

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	R5595	SD

General Provider Information

NPI Number	:	1942594213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NICOLE M MUSFELT

Provider Business Mailing Address
First Line	:	1415 EGLIN ST
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-9504
Country	:	US
Telephone Number	:	605-342-8621
Fax Number	:

Provider Business Practice Location Address
First Line	:	1415 EGLIN ST
Second Line	:	TARGET 2457
City	:	RAPID CITY
State	:	SD
Zip	:	57701-9504
Country	:	US
Telephone Number	:	65-341-8621
Fax Number	:

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

Provider Enumeration Date	:	06/04/2011
Last Update Date	:	06/04/2011

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