Provider Demographics
NPI:1851345094
Name:DWORNITSKI, NICHOLAS ANTHONY (RPH)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:ANTHONY
Last Name:DWORNITSKI
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 1:4225 BENSALEM BLVD
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-4917
Mailing Address - Country:US
Mailing Address - Phone:215-638-2852
Mailing Address - Fax:215-638-2852
Practice Address - Street 1:222 N 9TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-1822
Practice Address - Country:US
Practice Address - Phone:215-627-4567
Practice Address - Fax:215-627-4667
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP027892L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist