Provider Demographics
NPI:1386057834
Name:AMARAL, NICOL KIRSTEN (PHARMD)
Entity type:Individual
Prefix:
First Name:NICOL
Middle Name:KIRSTEN
Last Name:AMARAL
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:PO BOX 1136
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32961-1136
Mailing Address - Country:US
Mailing Address - Phone:772-559-5055
Mailing Address - Fax:
Practice Address - Street 1:1706 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-5545
Practice Address - Country:US
Practice Address - Phone:772-559-5055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23780183500000X
FLPS38031183500000X
SC35447183500000X
GARPH027165183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist