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NPI Code Detail

MEDICARE: RAPHAEL SIDIM UN RPH

MEDICARE: RAPHAEL SIDIM UN 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
1183500000XPharmacistRP045027LPA

General Provider Information

NPI Number : 1184941312
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAPHAEL SIDIM UN RPH
Provider Business Mailing Address
First Line : 6101 N BROAD ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19141-1931
Country : US
Telephone Number : 215-924-9645
Fax Number : 215-924-0547
Provider Business Practice Location Address
First Line : 6101 N BROAD ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19141-1931
Country : US
Telephone Number : 215-924-9645
Fax Number : 215-924-0547
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/28/2010
Last Update Date : 04/28/2010

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Directions to “ RAPHAEL SIDIM UN RPH” Practice Location

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