=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093038705
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MS. SOPHIA ACE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/09/2010
-----------------------------------------------------
Last Update Date | 03/09/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4401 BUFFALO RD
-----------------------------------------------------
City | ERIE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16510-2202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-898-1323
-----------------------------------------------------
Fax | 814-898-1587
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 211 LINDBERGH DR
-----------------------------------------------------
City | FAIRVIEW
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16415-1356
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-474-9295
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RP439043
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------