Provider Demographics
NPI:1679987200
Name:SMITHMYER, NICKOLAS
Entity Type:Individual
Prefix:
First Name:NICKOLAS
Middle Name:
Last Name:SMITHMYER
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 1:4011 WILLIAM PENN HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146
Mailing Address - Country:US
Mailing Address - Phone:412-372-5288
Mailing Address - Fax:
Practice Address - Street 1:4011 WILLIAM PENN HIGHWAY
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146
Practice Address - Country:US
Practice Address - Phone:412-372-5288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP446981183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist