Provider Demographics
NPI:1194149914
Name:ABO, NICOLA F (RPH)
Entity type:Individual
Prefix:
First Name:NICOLA
Middle Name:F
Last Name:ABO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4720 CLOUDY MORNING ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-4013
Mailing Address - Country:US
Mailing Address - Phone:702-557-7985
Mailing Address - Fax:
Practice Address - Street 1:4720 CLOUDY MORNING ST
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-4013
Practice Address - Country:US
Practice Address - Phone:702-557-7985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV18673183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist