Provider Demographics
NPI:1922312495
Name:DILISSIO, NICHOLAS PETER (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:PETER
Last Name:DILISSIO
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 MAIN STREET RITE AID PHARMACY
Mailing Address - Street 2:
Mailing Address - City:HARLEYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19438-2400
Mailing Address - Country:US
Mailing Address - Phone:215-256-4749
Mailing Address - Fax:
Practice Address - Street 1:270 MAIN ST
Practice Address - Street 2:
Practice Address - City:HARLEYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19438-2400
Practice Address - Country:US
Practice Address - Phone:215-256-4749
Practice Address - Fax:215-513-0227
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP025344L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist