Healthcare Provider Details

I. General information

NPI: 1932029048
Provider Name (Legal Business Name): NICHOLAS PAUL VERNACCHIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2026
Last Update Date: 07/18/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 STRAWBRIDGE DR
MOORESTOWN NJ
08057-4600
US

IV. Provider business mailing address

120 ARBORMOOR LN
MOYOCK NC
27958-6520
US

V. Phone/Fax

Practice location:
  • Phone: 866-648-2767
  • Fax:
Mailing address:
  • Phone: 804-205-6545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI04263600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: