MEDICARE: SOPHIA MARIE COTHREL HERBERT PHARMD

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	PI119446	PA

General Provider Information

NPI Number	:	1598225385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOPHIA MARIE COTHREL HERBERT PHARMD

Provider Business Mailing Address
First Line	:	7038 MEADE PL
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15208-2429
Country	:	US
Telephone Number	:	317-626-2416
Fax Number	:

Provider Business Practice Location Address
First Line	:	5607 BAUM BLVD RM 303
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15206-3701
Country	:	US
Telephone Number	:	317-626-2416
Fax Number	:

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

Provider Enumeration Date	:	03/20/2019
Last Update Date	:	01/16/2021

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