Nicole Leigh Elam, PHARMD.

Primary specialty

PharmacistTaxonomy code 183500000X

License

051.293487 Issued in IL

Practice address

1401 N 8TH St
Vandalia, IL 62471-1028

Phone

(618) 283-0196

NPI assigned

Nov 20, 2020

Last updated

Nov 20, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Miss Nicole Leigh Blankenship Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1605830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605830400000",
    "number": "1083217111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1465 COUNTRY CLUB AVE",
            "city": "SMITHBORO",
            "state": "IL",
            "postal_code": "622841021",
            "telephone_number": "618-780-9249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 N 8TH ST",
            "city": "VANDALIA",
            "state": "IL",
            "postal_code": "624711028",
            "telephone_number": "618-283-0196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELAM",
        "first_name": "NICOLE",
        "middle_name": "LEIGH",
        "name_prefix": "Mrs.",
        "credential": "PHARMD.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-11-20",
        "last_updated": "2020-11-20",
        "certification_date": "2020-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "IL",
            "license": "051.293487",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "BLANKENSHIP",
            "middle_name": "LEIGH",
            "prefix": "MISS",
            "credential": "PHARMD.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Pharmacist in Vandalia, IL
• Providers in Vandalia, IL by specialty
• Pharmacist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.