Provider Demographics
NPI:1225523152
Name:HASSON, NICOLE MANNELLA (PHARMD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:MANNELLA
Last Name:HASSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 CLEARVIEW DR
Mailing Address - Street 2:
Mailing Address - City:HOLLIDAYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16648-9279
Mailing Address - Country:US
Mailing Address - Phone:724-600-9481
Mailing Address - Fax:
Practice Address - Street 1:1333 PLANK RD STE 200
Practice Address - Street 2:
Practice Address - City:DUNCANSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16635-8456
Practice Address - Country:US
Practice Address - Phone:814-283-1821
Practice Address - Fax:814-283-2216
Is Sole Proprietor?:No
Enumeration Date:2018-06-23
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA174H00000X
PARP444577183500000X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1038342500001Medicaid