Provider Demographics
NPI:1861951345
Name:NEUKUM, NICOLE
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:NEUKUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14330 JARRETTSVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:MD
Mailing Address - Zip Code:21131-1743
Mailing Address - Country:US
Mailing Address - Phone:410-666-1700
Mailing Address - Fax:410-666-7140
Practice Address - Street 1:14330 JARRETTSVILLE PIKE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:MD
Practice Address - Zip Code:21131-1743
Practice Address - Country:US
Practice Address - Phone:410-666-1700
Practice Address - Fax:410-666-7140
Is Sole Proprietor?:No
Enumeration Date:2019-03-14
Last Update Date:2019-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD197261835P0018X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist