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General NPI Number Information
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NPI Number | 1649406919
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Entity Type | Individual
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Provider Name | NICKOLAS ALAN KERNICH PHARMD
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Gender | Male
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Dates
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Enumeration Date | 06/01/2009
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Last Update Date | 06/01/2009
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Provider Practice Location Address
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Address Line | 203 HAMPTON AVE
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City | PUNXSUTAWNEY
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State | PA
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Zip | 15767-2133
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Country | US
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Telephone | 814-938-9150
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Fax | 814-938-9151
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Provider Business Mailing Address
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Address Line | 203 HAMPTON AVE
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City | PUNXSUTAWNEY
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State | PA
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Zip | 15767-2133
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Country | US
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Telephone | 814-938-9150
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Fax | 814-938-9151
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RP442609
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License Number State | PA
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