Provider Demographics
NPI:1962943530
Name:PALKO, NOLAN RICHARD (PHARMD)
Entity type:Individual
Prefix:DR
First Name:NOLAN
Middle Name:RICHARD
Last Name:PALKO
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 1:6858 ROUTE 711
Mailing Address - Street 2:
Mailing Address - City:SEWARD
Mailing Address - State:PA
Mailing Address - Zip Code:15954-3130
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6858 ROUTE 711
Practice Address - Street 2:
Practice Address - City:SEWARD
Practice Address - State:PA
Practice Address - Zip Code:15954-3130
Practice Address - Country:US
Practice Address - Phone:814-446-5536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP449340183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist