Provider Demographics
NPI:1851652598
Name:SCIACCA, NICHOLAS ANDREW (PHARMD, BCACP)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:ANDREW
Last Name:SCIACCA
Suffix:
Gender:M
Credentials:PHARMD, BCACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9669 E 146TH ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-5005
Mailing Address - Country:US
Mailing Address - Phone:317-621-9346
Mailing Address - Fax:317-621-9676
Practice Address - Street 1:9669 E 146TH ST
Practice Address - Street 2:SUITE 250
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-5005
Practice Address - Country:US
Practice Address - Phone:317-621-9346
Practice Address - Fax:317-621-9676
Is Sole Proprietor?:No
Enumeration Date:2012-05-29
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26024053A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist