Healthcare Provider Details

I. General information

NPI: 1265037667
Provider Name (Legal Business Name): SULAIMAN SESAY PHAMD.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2020
Last Update Date: 12/02/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 S RICHLAND AVE
YORK PA
17404-3558
US

IV. Provider business mailing address

4 BRIDGEPORT CT APT 304
OWINGS MILLS MD
21117-5367
US

V. Phone/Fax

Practice location:
  • Phone: 717-843-4730
  • Fax:
Mailing address:
  • Phone: 240-603-7177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP454273
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: