Healthcare Provider Details

I. General information

NPI: 1699495051
Provider Name (Legal Business Name): NICOLE BENDIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2022
Last Update Date: 08/29/2022
Certification Date: 08/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

883 TUNNELTON RD
CLARKSBURG PA
15725-7616
US

IV. Provider business mailing address

883 TUNNELTON RD
CLARKSBURG PA
15725-7616
US

V. Phone/Fax

Practice location:
  • Phone: 724-762-3886
  • Fax:
Mailing address:
  • Phone: 724-762-3886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP457066
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: