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NPI Code Detail

MEDICARE: MS. SYLVIA LONGE EBANJA RPH

MEDICARE: MS. SYLVIA LONGE EBANJA RPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist21433NC

General Provider Information

NPI Number : 1053617191
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SYLVIA LONGE EBANJA RPH
Provider Business Mailing Address
First Line : 3300 STRAWBERRY RD
Second Line :
City : MATTHEWS
State : NC
Zip : 28104-6211
Country : US
Telephone Number : 617-785-4755
Fax Number :
Provider Business Practice Location Address
First Line : 1156 E CASWELL ST
Second Line :
City : WADESBORO
State : NC
Zip : 28170-2376
Country : US
Telephone Number : 704-694-2153
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/08/2011
Last Update Date : 02/08/2011

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