Healthcare Provider Details

I. General information

NPI: 1013031582
Provider Name (Legal Business Name): MARTHA SORRENTINO PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3010 FALSTAFF RD
RALEIGH NC
27610-1813
US

IV. Provider business mailing address

1012 OLDHAM FOREST CROSSING
CARY NC
27513
US

V. Phone/Fax

Practice location:
  • Phone: 919-250-3117
  • Fax: 919-250-3147
Mailing address:
  • Phone: 919-379-9245
  • Fax: 919-250-3147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number13248
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: