MEDICARE: ALLYSON NICOLA PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RP451035	PA
2	183500000X	Pharmacist	RPI010946	PA

General Provider Information

NPI Number	:	1053861732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLYSON NICOLA PHARMD

Provider Business Mailing Address
First Line	:	847 MIDLAND AVE
Second Line	:
City	:	MIDLAND
State	:	PA
Zip	:	15059-1511
Country	:	US
Telephone Number	:	724-643-6520
Fax Number	:

Provider Business Practice Location Address
First Line	:	847 MIDLAND AVE
Second Line	:
City	:	MIDLAND
State	:	PA
Zip	:	15059-1511
Country	:	US
Telephone Number	:	724-643-6520
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2016
Last Update Date	:	10/06/2016

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Directions to “ ALLYSON NICOLA PHARMD” Practice Location

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