Provider Demographics
NPI:1730543810
Name:NICOLADIS, KRISTEN CONERLY (RPH)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:CONERLY
Last Name:NICOLADIS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 TULANE AVE
Mailing Address - Street 2:SUITE 445
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-7462
Mailing Address - Country:US
Mailing Address - Phone:504-822-8013
Mailing Address - Fax:504-822-8141
Practice Address - Street 1:2601 TULANE AVE
Practice Address - Street 2:SUITE 445
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-7462
Practice Address - Country:US
Practice Address - Phone:504-822-8013
Practice Address - Fax:504-822-8141
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15182183500000X
TX32033183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist