Provider Demographics
NPI:1700439890
Name:TOE, NUEFORMIE KOLLIE (PHARMD)
Entity type:Individual
Prefix:
First Name:NUEFORMIE
Middle Name:KOLLIE
Last Name:TOE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3406 VINE CIR
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-4724
Mailing Address - Country:US
Mailing Address - Phone:774-502-1924
Mailing Address - Fax:
Practice Address - Street 1:11411 DEERFIELD DR
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-0506
Practice Address - Country:US
Practice Address - Phone:530-587-5775
Practice Address - Fax:530-587-2592
Is Sole Proprietor?:No
Enumeration Date:2019-07-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program