Healthcare Provider Details

I. General information

NPI: 1821078775
Provider Name (Legal Business Name): NICHOLAS BRABANDER PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

GEISINGER MEDICAL CENTER 100 N ACADEMY AVE SYSTEM THERAPEUTICS 42-01
DANVILLE PA
17822-0001
US

IV. Provider business mailing address

255 PATTON RD
DANVILLE PA
17821-7517
US

V. Phone/Fax

Practice location:
  • Phone: 570-271-5594
  • Fax:
Mailing address:
  • Phone: 570-271-1083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberRP037061R
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: