Provider Demographics
NPI:1588172365
Name:PATALANO-BICE, NICOLE TERESE
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:TERESE
Last Name:PATALANO-BICE
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 1:2501 E SUNRISE BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-3203
Mailing Address - Country:US
Mailing Address - Phone:954-564-5442
Mailing Address - Fax:
Practice Address - Street 1:18301 N MIAMI AVE STE 1
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169-4564
Practice Address - Country:US
Practice Address - Phone:305-760-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-16
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS61410183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist