Provider Demographics
NPI:1740883875
Name:DEPALMA, NICHOLAS
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:DEPALMA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 N GRAVEL PIKE
Mailing Address - Street 2:
Mailing Address - City:ZIEGLERVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19492-9727
Mailing Address - Country:US
Mailing Address - Phone:610-287-1032
Mailing Address - Fax:610-287-1032
Practice Address - Street 1:1206 N GRAVEL PIKE
Practice Address - Street 2:
Practice Address - City:ZIEGLERVILLE
Practice Address - State:PA
Practice Address - Zip Code:19492-9727
Practice Address - Country:US
Practice Address - Phone:610-287-1032
Practice Address - Fax:610-287-1032
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP038948L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist