Healthcare Provider Details

I. General information

NPI: 1154640738
Provider Name (Legal Business Name): PHILLIP DAVID SEBRELL PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2010
Last Update Date: 12/16/2022
Certification Date: 12/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 UPLAND SQ DR
STOWE PA
19464-9432
US

IV. Provider business mailing address

191 MASTERS DR
POTTSTOWN PA
19464-3493
US

V. Phone/Fax

Practice location:
  • Phone: 610-970-0004
  • Fax: 610-970-0007
Mailing address:
  • Phone: 215-715-8242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP438886
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: