Healthcare Provider Details

I. General information

NPI: 1770059024
Provider Name (Legal Business Name): NICHOLAS SHIALABBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2018
Last Update Date: 10/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 BROWNSVILLE RD STE 120
PITTSBURGH PA
15210-4273
US

IV. Provider business mailing address

328 E AGNEW AVE
PITTSBURGH PA
15210-4214
US

V. Phone/Fax

Practice location:
  • Phone: 412-881-6439
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP452890
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: