Provider Demographics
NPI:1700922325
Name:NOCKLEY FAMILY PHARMACY INC
Entity Type:Organization
Organization Name:NOCKLEY FAMILY PHARMACY INC
Other - Org Name:NOCKLEY FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:NOCKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHRMD
Authorized Official - Phone:570-814-1832
Mailing Address - Street 1:1198 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HANOVER TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18706-4030
Mailing Address - Country:US
Mailing Address - Phone:570-208-5500
Mailing Address - Fax:570-208-5490
Practice Address - Street 1:1198 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HANOVER TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18706-4030
Practice Address - Country:US
Practice Address - Phone:570-208-5500
Practice Address - Fax:570-208-5490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP4816783336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2081761OtherPK
3987851OtherNCPDP
5891150001Medicare NSC