Provider Demographics
NPI:1124531645
Name:RODIN, NICOLE (PHARMD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:RODIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:PEREA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2223 W EVERETT AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-5653
Mailing Address - Country:US
Mailing Address - Phone:505-463-3403
Mailing Address - Fax:
Practice Address - Street 1:205 E SPOKANE FALLS BLVD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202
Practice Address - Country:US
Practice Address - Phone:505-463-3403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-06
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00008765183500000X
WAPH60782161183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPH60782161OtherWASHINGTON DEPARTMENT OF HEALTH
IDP7978OtherIDAHO BOARD OF PHARMACY
NMRP00008765OtherNEW MEXICO BOARD OF PHARMACY