Provider Demographics
NPI:1225999030
Name:SHOEMAKER, NICOLE P
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:P
Last Name:SHOEMAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7164 RUSHING WATER CT
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORT
Mailing Address - State:AL
Mailing Address - Zip Code:36527-9085
Mailing Address - Country:US
Mailing Address - Phone:251-625-4654
Mailing Address - Fax:
Practice Address - Street 1:30957 MILL LN
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36527-5453
Practice Address - Country:US
Practice Address - Phone:251-625-4654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-20
Last Update Date:2025-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL24336183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist