Active NPI
Bernadette Cruz Nicolas, RPH
- Pharmacist
- Fort Oglethorpe, GA
National Provider Identifier
1356475792
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 23119
- Practice address
- 3040 Battlefield Pkwy
Fort Oglethorpe, GA 30742-4004 - Phone
- (706) 861-6252
- NPI assigned
- Mar 16, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 23119 | TN | Primary |
| Pharmacist | 183500000X | RPH023558 | GA |
Addresses
Primary practice location
3040 Battlefield Pkwy
Fort Oglethorpe, GA 30742-4004
Mailing address
3206 Regency CT
Chattanooga, TN 37421-7622
Phone (423) 313-4847
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPH023558 | GA | MD | Pharmacist |
| 23119 | TN | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174003200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184716800000",
"number": "1356475792",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3206 REGENCY CT",
"city": "CHATTANOOGA",
"state": "TN",
"postal_code": "374217622",
"telephone_number": "423-313-4847"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3040 BATTLEFIELD PKWY",
"city": "FORT OGLETHORPE",
"state": "GA",
"postal_code": "307424004",
"telephone_number": "706-861-6252"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICOLAS",
"first_name": "BERNADETTE",
"middle_name": "CRUZ",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-16",
"last_updated": "2007-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TN",
"license": "23119",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "GA",
"license": "RPH023558",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Oglethorpe, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.