MEDICARE: NICHOLAS PETER DILISSIO PHARMACIST

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	RP025344L	PA

General Provider Information

NPI Number	:	1922312495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS PETER DILISSIO PHARMACIST

Provider Business Mailing Address
First Line	:	270 MAIN STREET RITE AID PHARMACY
Second Line	:
City	:	HARLEYSVILLE
State	:	PA
Zip	:	19438-2400
Country	:	US
Telephone Number	:	215-256-4749
Fax Number	:

Provider Business Practice Location Address
First Line	:	270 MAIN ST
Second Line	:
City	:	HARLEYSVILLE
State	:	PA
Zip	:	19438-2400
Country	:	US
Telephone Number	:	215-256-4749
Fax Number	:	215-513-0227

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

Provider Enumeration Date	:	07/27/2010
Last Update Date	:	07/27/2010

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