Healthcare Provider Details

I. General information

NPI: 1144144858
Provider Name (Legal Business Name): SIDRA TAHER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 SICKLERVILLE RD UNIT C1
SICKLERVILLE NJ
08081-2556
US

IV. Provider business mailing address

416 SICKLERVILLE RD UNIT C1
SICKLERVILLE NJ
08081-2556
US

V. Phone/Fax

Practice location:
  • Phone: 856-566-1100
  • Fax: 856-566-1102
Mailing address:
  • Phone: 856-566-1100
  • Fax: 856-566-1102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number28RS00812600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: