Provider Demographics
NPI:1194037143
Name:FEUDALE, SVETLANA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SVETLANA
Middle Name:
Last Name:FEUDALE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MISS
Other - First Name:SVETLANA
Other - Middle Name:
Other - Last Name:TSIMBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:116 HORSESHOE DR
Mailing Address - Street 2:
Mailing Address - City:MANTUA
Mailing Address - State:NJ
Mailing Address - Zip Code:08051-1332
Mailing Address - Country:US
Mailing Address - Phone:267-825-5109
Mailing Address - Fax:
Practice Address - Street 1:9773 ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19114-1010
Practice Address - Country:US
Practice Address - Phone:215-673-0747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-07
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP439482183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist