MEDICARE: NICHOLAS JOHN VERGARI PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	070778	NY

General Provider Information

NPI Number	:	1235917980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS JOHN VERGARI PHARMD

Provider Business Mailing Address
First Line	:	82 HIDDEN CREEK LN
Second Line	:
City	:	HAMLIN
State	:	NY
Zip	:	14464-9530
Country	:	US
Telephone Number	:	585-953-4455
Fax Number	:

Provider Business Practice Location Address
First Line	:	2161 FAIRPORT NINE MILE PT RD
Second Line	:
City	:	FAIRPORT
State	:	NY
Zip	:	14450-8509
Country	:	US
Telephone Number	:	585-377-1196
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2023
Last Update Date	:	09/14/2023

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