Healthcare Provider Details

I. General information

NPI: 1306080288
Provider Name (Legal Business Name): PHONGSIRI SIVASEN YEE RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2009
Last Update Date: 04/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 EDGEMONT AVE
BROOKHAVEN PA
19015-1202
US

IV. Provider business mailing address

908 COPELAND SCHOOL ROAD
WEST CHESTER PA
19830-1828
US

V. Phone/Fax

Practice location:
  • Phone: 610-872-4346
  • Fax: 610-872-4574
Mailing address:
  • Phone: 610-872-4346
  • Fax: 610-872-4574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP045015R
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberA1-0003250
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: