Healthcare Provider Details

I. General information

NPI: 1255659702
Provider Name (Legal Business Name): SHERRY ANN DYBOWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2010
Last Update Date: 05/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 BERK RD
LEESPORT PA
19533-8705
US

IV. Provider business mailing address

1011 BERK RD
LEESPORT PA
19533-8705
US

V. Phone/Fax

Practice location:
  • Phone: 610-373-1600
  • Fax: 670-376-4841
Mailing address:
  • Phone: 610-373-1600
  • Fax: 670-376-4841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP041937L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: