Healthcare Provider Details

I. General information

NPI: 1710209556
Provider Name (Legal Business Name): NICHOLAS ANTHONY FICALORA PHARM D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2010
Last Update Date: 02/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S WELLWOOD AVE
LINDENHURST NY
11757-4901
US

IV. Provider business mailing address

150 S WELLWOOD AVE
LINDENHURST NY
11757-4901
US

V. Phone/Fax

Practice location:
  • Phone: 631-225-5192
  • Fax: 631-225-4027
Mailing address:
  • Phone: 631-225-5192
  • Fax: 631-225-4027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number049962-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: