Provider Demographics
NPI:1962533943
Name:DE PADOVA, NICOLAS (PHARMD)
Entity type:Individual
Prefix:DR
First Name:NICOLAS
Middle Name:
Last Name:DE PADOVA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2946 E BANNER GATEWAY DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2165
Mailing Address - Country:US
Mailing Address - Phone:480-256-4448
Mailing Address - Fax:480-256-3608
Practice Address - Street 1:2946 E BANNER GATEWAY DR
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2165
Practice Address - Country:US
Practice Address - Phone:480-256-4448
Practice Address - Fax:480-256-3608
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP70381835X0200X, 1835X0200X
FLPS37015183500000X
NV17767183500000X
ORRPH-0013539183500000X
AZS0177951835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology
No183500000XPharmacy Service ProvidersPharmacist