Provider Demographics
NPI:1215531306
Name:NOTHSTEIN, ALICIA
Entity type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:
Last Name:NOTHSTEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:958 ROUTE 390
Mailing Address - Street 2:
Mailing Address - City:CRESCO
Mailing Address - State:PA
Mailing Address - Zip Code:18326-7909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:958 ROUTE 390
Practice Address - Street 2:
Practice Address - City:CRESCO
Practice Address - State:PA
Practice Address - Zip Code:18326-7909
Practice Address - Country:US
Practice Address - Phone:570-595-7131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP445155183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist