Provider Demographics
NPI:1104198340
Name:STONE, NICOLE (PHARM D)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:STONE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 INNIS DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-6627
Mailing Address - Country:US
Mailing Address - Phone:540-854-0574
Mailing Address - Fax:
Practice Address - Street 1:11010 KENTUCKY SPRINGS RD
Practice Address - Street 2:
Practice Address - City:MINERAL
Practice Address - State:VA
Practice Address - Zip Code:23117-5069
Practice Address - Country:US
Practice Address - Phone:540-894-0650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202210324183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist