1124531645 NPI number — NICOLE RODIN PHARMD

Table of content: NICOLE RODIN PHARMD (NPI 1124531645)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124531645 NPI number — NICOLE RODIN PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RODIN
Provider First Name:
NICOLE
Provider Middle Name:
Provider Name Prefix Text:
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:
PEREA
Provider Other First Name:
NICOLE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARMD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1124531645
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/31/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2223 W EVERETT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPOKANE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99205-5653
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-463-3403
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 E SPOKANE FALLS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-463-3403
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/06/2017

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: 183500000X , with the licence number:  RP00008765 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 183500000X , with the licence number: PH60782161 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PH60782161 . This is a "WASHINGTON DEPARTMENT OF HEALTH" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: P7978 . This is a "IDAHO BOARD OF PHARMACY" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: RP00008765 . This is a "NEW MEXICO BOARD OF PHARMACY" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




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