Healthcare Provider Details

I. General information

NPI: 1144083346
Provider Name (Legal Business Name): JONATHAN REIBSTEIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2024
Last Update Date: 02/01/2024
Certification Date: 02/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 TITUS AVE
WARRINGTON PA
18976-2424
US

IV. Provider business mailing address

125 TITUS AVE
WARRINGTON PA
18976-2424
US

V. Phone/Fax

Practice location:
  • Phone: 267-614-3549
  • Fax: 267-487-8960
Mailing address:
  • Phone: 267-614-3549
  • Fax: 267-487-8960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP042085L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: