Provider Demographics
NPI:1194919464
Name:NICOLE AND ANDRE PHARMACEUTICAL INC.
Entity type:Organization
Organization Name:NICOLE AND ANDRE PHARMACEUTICAL INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ODETTE
Authorized Official - Middle Name:P
Authorized Official - Last Name:KHALIL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:562-789-5852
Mailing Address - Street 1:9209 COLIMA RD STE 1100
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90605-1863
Mailing Address - Country:US
Mailing Address - Phone:562-789-5852
Mailing Address - Fax:562-789-5854
Practice Address - Street 1:510 W MAIN ST STE 111
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-2900
Practice Address - Country:US
Practice Address - Phone:562-789-5852
Practice Address - Fax:562-789-5854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4802220002Medicare NSC