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General NPI Number Information
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NPI Number | 1518279272
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Entity Type | Individual
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Provider Name | SALLY LYNNE FELLOWS
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Gender | Female
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Dates
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Enumeration Date | 07/10/2010
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Last Update Date | 07/10/2010
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Provider Practice Location Address
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Address Line | 412 BROADWAY ST
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City | CORAOPOLIS
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State | PA
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Zip | 15108-1632
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Country | US
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Telephone | 412-264-0810
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Fax |
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Provider Business Mailing Address
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Address Line | 201 OAK HIGHLAND DR
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City | MOON TWP
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State | PA
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Zip | 15108-1363
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Country | US
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Telephone | 412-264-3630
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RP034555R
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License Number State | PA
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