Provider Demographics
NPI:1558412767
Name:PSOMAS, NICHOLAS G (RPH)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:G
Last Name:PSOMAS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:544 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07513-1426
Mailing Address - Country:US
Mailing Address - Phone:973-279-0707
Mailing Address - Fax:973-684-4408
Practice Address - Street 1:544 MARKET ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07513-1426
Practice Address - Country:US
Practice Address - Phone:973-279-0707
Practice Address - Fax:973-684-4408
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01954500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist