Provider Demographics
NPI:1184023962
Name:NOLAN, MICHAEL (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:NOLAN
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5631 STATE HIGHWAY 12
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815-3205
Mailing Address - Country:US
Mailing Address - Phone:607-336-2774
Mailing Address - Fax:607-336-2666
Practice Address - Street 1:5631 STATE HIGHWAY 12
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-3205
Practice Address - Country:US
Practice Address - Phone:607-336-2774
Practice Address - Fax:607-336-2666
Is Sole Proprietor?:No
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058125183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY058125OtherNYSED