Provider Demographics
NPI:1992030019
Name:CABRERA, NICOLE ANNE (RPH)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:ANNE
Last Name:CABRERA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 OLD STAGE RD
Mailing Address - Street 2:
Mailing Address - City:SPOTSWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08884-1231
Mailing Address - Country:US
Mailing Address - Phone:732-251-5214
Mailing Address - Fax:
Practice Address - Street 1:65 OLD STAGE RD
Practice Address - Street 2:
Practice Address - City:SPOTSWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08884-1231
Practice Address - Country:US
Practice Address - Phone:732-251-5214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02678400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist