Provider Demographics
NPI:1063597938
Name:LAHAIE, NICOLE A (PHARMD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:A
Last Name:LAHAIE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:NICOLE
Other - Middle Name:A
Other - Last Name:LAHAIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1579 INDIAN TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:CHEBOYGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49721-9637
Mailing Address - Country:US
Mailing Address - Phone:231-627-5006
Mailing Address - Fax:
Practice Address - Street 1:950 EDELWEISS PARKWAY
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735
Practice Address - Country:US
Practice Address - Phone:989-732-8998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302034123183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist