Basic Information
| Provider Information | |||||||||
| NPI: | 1184962656 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FRETWELL | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | HELENE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 225 N 1ST ST | ||||||||
| Address2: | |||||||||
| City: | LEESBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347485150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523147403 | ||||||||
| FaxNumber: | 3523600007 | ||||||||
| Practice Location | |||||||||
| Address1: | 225 N 1ST ST | ||||||||
| Address2: | |||||||||
| City: | LEESBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347485150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523147403 | ||||||||
| FaxNumber: | 3523600007 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2013 | ||||||||
| LastUpdateDate: | 08/19/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | PS49109 | FL | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.