Provider Demographics
NPI:1114598349
Name:ONCKEN, NICOLE MARIE (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:ONCKEN
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 RUEMMELE RD APT 205
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-6436
Mailing Address - Country:US
Mailing Address - Phone:701-317-0779
Mailing Address - Fax:
Practice Address - Street 1:4440 S WASHINGTON ST STE 101D
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-7245
Practice Address - Country:US
Practice Address - Phone:701-732-2900
Practice Address - Fax:701-732-2909
Is Sole Proprietor?:No
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDRPH6314183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist