Provider Demographics
NPI:1093038705
Name:ACE, SOPHIA
Entity Type:Individual
Prefix:MS
First Name:SOPHIA
Middle Name:
Last Name:ACE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 LINDBERGH DR
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:PA
Mailing Address - Zip Code:16415-1356
Mailing Address - Country:US
Mailing Address - Phone:814-474-9295
Mailing Address - Fax:
Practice Address - Street 1:4401 BUFFALO RD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16510-2202
Practice Address - Country:US
Practice Address - Phone:814-898-1323
Practice Address - Fax:814-898-1587
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP439043183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist