=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275966624
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AILA JOHANNA SPIEGEL PHARM.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/20/2013
-----------------------------------------------------
Last Update Date | 08/20/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1400 BLACKHORSE HILL RD PHARMACY
-----------------------------------------------------
City | COATESVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19320-2040
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-384-7711
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 40 HICKORY DR
-----------------------------------------------------
City | NORTH EAST
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21901-3603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-367-5217
-----------------------------------------------------
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 | 21890
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------