Nicole Corina Mayne, PHARMD

Primary specialty

Clinic PharmacyTaxonomy code 3336C0002X

License

PHA-PHA-LIC-62959 Issued in MT

Practice address

931 Highland Blvd Ste 3130
Bozeman, MT 59715-6914

Phone

(303) 921-9545

NPI assigned

Mar 17, 2021

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

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

{
    "created_epoch": "1615939200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615939200000",
    "number": "1952986200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1541 POWERS BLVD",
            "city": "BELGRADE",
            "state": "MT",
            "postal_code": "597147723",
            "telephone_number": "303-921-9545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "931 HIGHLAND BLVD STE 3130",
            "city": "BOZEMAN",
            "state": "MT",
            "postal_code": "597156914",
            "telephone_number": "303-921-9545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAYNE",
        "first_name": "NICOLE",
        "middle_name": "CORINA",
        "credential": "PHARMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-03-17",
        "last_updated": "2021-03-17",
        "certification_date": "2021-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "MT",
            "license": "PHA-PHA-LIC-62959",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly Annette Maxwell, D.C.
• Michael C Maxwell, M.D.
• Kenneth Francis May Jr., M.D., PH.D.
• Konnor Andrew May, DC
• Steffan John May, M.D.
• Ashley Tyrell McAdam, RBT
• Aubrey McAtee
• Cody Alan McBeath, LAC.
• Scott McBride
• John Waldron McCahan, MD

• Clinic Pharmacy in Bozeman, MT
• Providers in Bozeman, MT by specialty
• Clinic Pharmacy in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2021; 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.