Provider Demographics
NPI:1437186277
Name:NAN, MICHAEL TERRY (RPH)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:TERRY
Last Name:NAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 MASONIC DR
Mailing Address - Street 2:
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143-2328
Mailing Address - Country:US
Mailing Address - Phone:412-741-0104
Mailing Address - Fax:412-741-6802
Practice Address - Street 1:1000 MASONIC DR
Practice Address - Street 2:
Practice Address - City:SEWICKLEY
Practice Address - State:PA
Practice Address - Zip Code:15143-2328
Practice Address - Country:US
Practice Address - Phone:412-741-0104
Practice Address - Fax:412-741-6802
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP039120L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP039120LOtherSTATE PHARMACIST LICENSE