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NICHOLAS SERVATI
Complete NPI Record 1285280693
Pharmacist - Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Worcester, MA

NPI Status: Active since August 12, 2019

Contact Information

55 LAKE AVENUE NORTH
DEPARTMENT OF PHARMACY
WORCESTER, MA
ZIP 01655
Phone: (774) 441-1532

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Provider Last Name Legal Name
  4. Provider First Name
  5. Provider First Line Business Mailing Address
  6. Provider Second Line Business Mailing Address
  7. Provider Business Mailing Address City Name
  8. Provider Business Mailing Address State Name
  9. Provider Business Mailing Address Postal Code
  10. Provider Business Mailing Address Country Code If outside U S
  11. Provider First Line Business Practice Location Address
  12. Provider Second Line Business Practice Location Address
  13. Provider Business Practice Location Address City Name
  14. Provider Business Practice Location Address State Name
  15. Provider Business Practice Location Address Postal Code
  16. Provider Business Practice Location Address Country Code If outside U S
  17. Provider Business Practice Location Address Telephone Number
  18. Provider Enumeration Date
  19. Last Update Date
  20. Provider Gender Code
  21. Healthcare Provider Taxonomy Code 1
  22. Provider License Number 1
  23. Provider License Number State Code 1
  24. Healthcare Provider Primary Taxonomy Switch 1
  25. Is Sole Proprietor

Complete NPI Dataset

This page represents the complete record for NPI 1285280693. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1285280693
The date the provider was assigned a unique identifier (assigned an NPI).
Entity Type Code: 1
The date that a record was last updated or changed.
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Provider First Name: NICHOLAS
The first name of the authorized official.
Provider First Line Business Mailing Address: 55 LAKE AVENUE
The title or position of the authorized official.
Provider Second Line Business Mailing Address: DEPARTMENT OF PHARMACY
The second line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider second line location address’’.
Provider Business Mailing Address City Name: WORCESTER
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: MA
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 01655
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider First Line Business Practice Location Address: 55 LAKE AVENUE NORTH
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Second Line Business Practice Location Address: DEPARTMENT OF PHARMACY
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: WORCESTER
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: MA
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 01655
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 7744411532
The telephone number associated with the location address of the provider being identified.
Provider Enumeration Date: 8/12/2019
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 8/12/2019
The date that a record was last updated or changed.
Provider Gender Code: M
The code designating the provider’s gender if the provider is a person.
Healthcare Provider Taxonomy Code 1: 1835P0018X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 1: PH238460
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 1: MA
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1: Y
Is Sole Proprietor: N
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No