Healthcare Provider Details

I. General information

NPI: 1497579296
Provider Name (Legal Business Name): GABRIELLE CHRISTINA FENDRICH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2024
Last Update Date: 11/09/2024
Certification Date: 11/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 SUSQUEHANNA RD
ROSLYN PA
19001-4211
US

IV. Provider business mailing address

2350 SUSQUEHANNA RD
ROSLYN PA
19001-4211
US

V. Phone/Fax

Practice location:
  • Phone: 215-881-9508
  • Fax:
Mailing address:
  • Phone: 215-881-9508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP459051
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: