Healthcare Provider Details

I. General information

NPI: 1346569381
Provider Name (Legal Business Name): SARAH NSIBIRWA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2010
Last Update Date: 05/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 CITY AVE
PHILADELPHIA PA
19131-4190
US

IV. Provider business mailing address

711 CONSHOHOCKEN STATE RD
BALA CYNWYD PA
19004-2103
US

V. Phone/Fax

Practice location:
  • Phone: 215-877-2116
  • Fax:
Mailing address:
  • Phone: 610-949-0493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP041283R
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: