Provider Demographics
NPI:1518568310
Name:NIKOLAUS, PAUL JAMES (RPH)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:JAMES
Last Name:NIKOLAUS
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 1:3645 KENNEL AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNTVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17554-1151
Mailing Address - Country:US
Mailing Address - Phone:717-468-9715
Mailing Address - Fax:
Practice Address - Street 1:2641 SHILLINGTON RD
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19608-1757
Practice Address - Country:US
Practice Address - Phone:610-678-3335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP036749L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist