Provider Demographics
NPI:1861150500
Name:STADLER, NICOLE M (PHARMD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:STADLER
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 1:782 BLUE MOON CT
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-9861
Mailing Address - Country:US
Mailing Address - Phone:815-981-1996
Mailing Address - Fax:
Practice Address - Street 1:2825 W PERIMETER RD STE 112
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46241-3614
Practice Address - Country:US
Practice Address - Phone:800-870-6419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26026269A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty