Provider Demographics
NPI:1285154310
Name:SAMUELS, NICOLE (PHARM D)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:SAMUELS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:SAMUELS
Other - Last Name:CABIGAO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARM D
Mailing Address - Street 1:3800 HIGHLAND PARK PL
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-6923
Mailing Address - Country:US
Mailing Address - Phone:901-409-9976
Mailing Address - Fax:
Practice Address - Street 1:11888 HIGHWAY 70
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38002-8585
Practice Address - Country:US
Practice Address - Phone:901-867-2041
Practice Address - Fax:901-867-3029
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000034350183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist