Provider Demographics
NPI:1538591367
Name:PIZARRO, NICOLE ANNEMARIE (PHARMD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANNEMARIE
Last Name:PIZARRO
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 1:506 REGENTS CROSSE LN APT 4C
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23238-5594
Mailing Address - Country:US
Mailing Address - Phone:412-770-5176
Mailing Address - Fax:
Practice Address - Street 1:11290 W BROAD ST
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-5815
Practice Address - Country:US
Practice Address - Phone:804-360-8912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-03
Last Update Date:2013-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202211572183500000X
PARP447413183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist