Provider Demographics
NPI:1366449936
Name:DEBALKO, JOHN NICHOLAS (RPH, PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:NICHOLAS
Last Name:DEBALKO
Suffix:
Gender:M
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 S CLEVELAND ST
Mailing Address - Street 2:
Mailing Address - City:MCADOO
Mailing Address - State:PA
Mailing Address - Zip Code:18237-1741
Mailing Address - Country:US
Mailing Address - Phone:570-929-3218
Mailing Address - Fax:570-929-1208
Practice Address - Street 1:500 S CLEVELAND ST
Practice Address - Street 2:
Practice Address - City:MCADOO
Practice Address - State:PA
Practice Address - Zip Code:18237-1741
Practice Address - Country:US
Practice Address - Phone:570-929-3218
Practice Address - Fax:570-929-1208
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP028926L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP028926LOtherPHARMACIST LICENSE