Provider Demographics
NPI:1023726387
Name:DEROSA, NICHOLAS GEORGE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:GEORGE
Last Name:DEROSA
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 1:50 PARKER RD
Mailing Address - Street 2:
Mailing Address - City:DRACUT
Mailing Address - State:MA
Mailing Address - Zip Code:01826-4244
Mailing Address - Country:US
Mailing Address - Phone:978-551-3735
Mailing Address - Fax:
Practice Address - Street 1:161 MAIN ST
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-4329
Practice Address - Country:US
Practice Address - Phone:978-551-3735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA240679183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist