1740503846 NPI number — DR. NICOLE NOEL PITELLO PHARMD

Table of content: DR. NICOLE NOEL PITELLO PHARMD (NPI 1740503846)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740503846 NPI number — DR. NICOLE NOEL PITELLO PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PITELLO
Provider First Name:
NICOLE
Provider Middle Name:
NOEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MORGAN
Provider Other First Name:
NICOLE
Provider Other Middle Name:
NOEL
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARMD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1740503846
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1701 N SENATE BLVD
Provider Second Line Business Mailing Address:
AG 401
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46202-1239
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-962-8112
Provider Business Mailing Address Fax Number:
317-962-9090

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1701 N SENATE BLVD
Provider Second Line Business Practice Location Address:
AG 401
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46202-1239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-962-8112
Provider Business Practice Location Address Fax Number:
317-962-9090
Provider Enumeration Date:
03/04/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1835P0018X , with the licence number:  26022558A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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