Healthcare Provider Details

I. General information

NPI: 1619514429
Provider Name (Legal Business Name): KATHERINE SYPHARD RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2019
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39820 HICKMAN PLAZA RD
BETHANY BEACH DE
19930-3760
US

IV. Provider business mailing address

36252 LIGHTHOUSE RD
SELBYVILLE DE
19975-3912
US

V. Phone/Fax

Practice location:
  • Phone: 302-539-3548
  • Fax:
Mailing address:
  • Phone: 302-436-6411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26317
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberA1-0005342
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: