Provider Demographics
NPI:1164298543
Name:SUPERKO, NICHOLAS ALAN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:ALAN
Last Name:SUPERKO
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 1:241 DOOLITTLE HILL RD
Mailing Address - Street 2:
Mailing Address - City:LACEYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18623-6637
Mailing Address - Country:US
Mailing Address - Phone:570-721-5209
Mailing Address - Fax:
Practice Address - Street 1:50 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:TUNKHANNOCK
Practice Address - State:PA
Practice Address - Zip Code:18657-1502
Practice Address - Country:US
Practice Address - Phone:570-836-6667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-28
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP458903183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist