MEDICARE: SARAH M DIFEBO

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
1	183500000X	Pharmacist	RP442900	PA

General Provider Information

NPI Number	:	1528685195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH M DIFEBO

Provider Business Mailing Address
First Line	:	40 COOPERTOWN RD
Second Line	:
City	:	HAVERFORD
State	:	PA
Zip	:	19041-1013
Country	:	US
Telephone Number	:	570-336-6217
Fax Number	:

Provider Business Practice Location Address
First Line	:	518 PORT ROYAL AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19128-2144
Country	:	US
Telephone Number	:	215-483-6680
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2020
Last Update Date	:	06/30/2020

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Directions to “ SARAH M DIFEBO ” Practice Location

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