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General NPI Number Information
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NPI Number | 1598983272
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Entity Type | Individual
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Provider Name | EMMERLYN E IBEREDEM RPH
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Gender | Male
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 208 N 3RD ST SUITE 120
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City | HARRISBURG
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State | PA
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Zip | 17101-1512
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Country | US
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Telephone | 717-232-4101
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Fax | 717-214-7696
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Provider Business Mailing Address
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Address Line | 2034 COVEY CT
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City | HARRISBURG
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State | PA
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Zip | 17110-3665
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Country | US
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Telephone | 717-540-8546
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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 | RP033326L
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License Number State | PA
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