Provider Demographics
NPI:1447582127
Name:NANKIN, DAVID PHILLIP (RPH)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:PHILLIP
Last Name:NANKIN
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 1:10 COBBLESTONE DR.
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-9216
Mailing Address - Country:US
Mailing Address - Phone:585-223-8870
Mailing Address - Fax:
Practice Address - Street 1:10 COBBLESTONE COURT DR
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-1044
Practice Address - Country:US
Practice Address - Phone:585-223-8870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30048183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY30048Medicaid