Provider Demographics
NPI:1275213449
Name:KUMAR, SASIREKHA (PHARMD)
Entity Type:Individual
Prefix:
First Name:SASIREKHA
Middle Name:
Last Name:KUMAR
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 KEELY CT
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-2979
Mailing Address - Country:US
Mailing Address - Phone:267-592-8891
Mailing Address - Fax:
Practice Address - Street 1:11750 BUSTLETON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-2516
Practice Address - Country:US
Practice Address - Phone:215-934-6221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-21
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP457569183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist