Provider Demographics
NPI:1104601186
Name:APA, NICOLE ANNE MAGSAMBOL
Entity type:Individual
Prefix:
First Name:NICOLE ANNE
Middle Name:MAGSAMBOL
Last Name:APA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 ALBANY ST
Mailing Address - Street 2:
Mailing Address - City:BEECH GROVE
Mailing Address - State:IN
Mailing Address - Zip Code:46107-1404
Mailing Address - Country:US
Mailing Address - Phone:317-786-1031
Mailing Address - Fax:317-786-1036
Practice Address - Street 1:1808 ALBANY ST
Practice Address - Street 2:
Practice Address - City:BEECH GROVE
Practice Address - State:IN
Practice Address - Zip Code:46107-1404
Practice Address - Country:US
Practice Address - Phone:317-786-1031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26030481A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist