Nicole Gorman
Individual provider Active NPI Pharmacist · Kingston, MA
NPI 1669190047 · NPPES record last updated Aug 22, 2022
Key facts
- NPI
- 1669190047
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- PH234630 (MA)
- Practice address
- 101 Independence Mall Way
Kingston, MA 02364-3048 - Phone
- (781) 585-6337
- NPI assigned
- Aug 22, 2022
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PH234630 | MA | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PH234630 | MA | Yes |
Addresses
Primary practice location
101 Independence Mall Way
Kingston, MA 02364-3048
Mailing address
101 Independence Mall Way
Kingston, MA 02364-3048
Other providers in Kingston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2022. 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.