=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700922325
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NOCKLEY FAMILY PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2007
-----------------------------------------------------
Last Update Date | 10/25/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1198 S MAIN ST
-----------------------------------------------------
City | HANOVER TOWNSHIP
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18706-4030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-208-5500
-----------------------------------------------------
Fax | 570-208-5490
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1198 S MAIN ST
-----------------------------------------------------
City | HANOVER TOWNSHIP
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18706-4030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-208-5500
-----------------------------------------------------
Fax | 570-208-5490
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DAVID NOCKLEY
-----------------------------------------------------
Credential | PHRMD
-----------------------------------------------------
Telephone | 570-814-1832
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PP481678
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------