Provider Demographics
NPI:1992986913
Name:STARE, NICOLE RENEE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:RENEE
Last Name:STARE
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 1:100 CONHOCTON ST
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:NY
Mailing Address - Zip Code:14830-2958
Mailing Address - Country:US
Mailing Address - Phone:607-962-3111
Mailing Address - Fax:
Practice Address - Street 1:100 CONHOCTON ST
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830-2958
Practice Address - Country:US
Practice Address - Phone:607-962-3111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20 051579183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007308150127Medicaid