Provider Demographics
NPI:1245804848
Name:GURSKI, NICHOLAS JAMES
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:JAMES
Last Name:GURSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 NEW ROAD
Mailing Address - Street 2:
Mailing Address - City:LOST CREEK
Mailing Address - State:PA
Mailing Address - Zip Code:17946
Mailing Address - Country:US
Mailing Address - Phone:570-985-3721
Mailing Address - Fax:
Practice Address - Street 1:509 DAVIS ST
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18505-2927
Practice Address - Country:US
Practice Address - Phone:570-341-3790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPI121468183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist