Provider Demographics
NPI:1649406919
Name:KERNICH, NICKOLAS ALAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NICKOLAS
Middle Name:ALAN
Last Name:KERNICH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 HAMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:PUNXSUTAWNEY
Mailing Address - State:PA
Mailing Address - Zip Code:15767-2133
Mailing Address - Country:US
Mailing Address - Phone:814-938-9150
Mailing Address - Fax:814-938-9151
Practice Address - Street 1:203 HAMPTON AVE
Practice Address - Street 2:
Practice Address - City:PUNXSUTAWNEY
Practice Address - State:PA
Practice Address - Zip Code:15767-2133
Practice Address - Country:US
Practice Address - Phone:814-938-9150
Practice Address - Fax:814-938-9151
Is Sole Proprietor?:No
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP442609183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP442609OtherPHARMACY