Provider Demographics
NPI:1295974806
Name:REBMANN, NICHOLAS EDWARD (PHARM D)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:EDWARD
Last Name:REBMANN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:WATERVLIET
Mailing Address - State:NY
Mailing Address - Zip Code:12189-2211
Mailing Address - Country:US
Mailing Address - Phone:518-271-0311
Mailing Address - Fax:
Practice Address - Street 1:1901 2ND AVE
Practice Address - Street 2:
Practice Address - City:WATERVLIET
Practice Address - State:NY
Practice Address - Zip Code:12189-2211
Practice Address - Country:US
Practice Address - Phone:518-271-0311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-05
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052602183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist