Provider Demographics
NPI:1194433433
Name:PAGE, NICKAYLA (PHARMD)
Entity type:Individual
Prefix:
First Name:NICKAYLA
Middle Name:
Last Name:PAGE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 POINT GROVE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHWICK
Mailing Address - State:MA
Mailing Address - Zip Code:01077-9603
Mailing Address - Country:US
Mailing Address - Phone:413-530-5578
Mailing Address - Fax:
Practice Address - Street 1:165 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-8900
Practice Address - Country:US
Practice Address - Phone:413-256-0421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH241230183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist