Nicole Marie Boustead, PHARM.D
Individual provider Active NPI Pharmacist · Bismarck, ND
NPI 1235169673 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1235169673
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 4825 (ND)
- Practice address
- 900 E Broadway Ave
Bismarck, ND 58501-4520 - Phone
- (701) 530-6906
- Fax
- (701) 530-6907
- NPI assigned
- Jul 3, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4825 | ND | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 4825 | ND | Yes |
Addresses
Primary practice location
900 E Broadway Ave
Bismarck, ND 58501-4520
Mailing address
789 San Angelo Dr
Bismarck, ND 58504-7441
Phone (701) 255-1673
Other providers in Bismarck, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.