Provider Demographics
NPI:1407073307
Name:DARK, AISHA
Entity Type:Individual
Prefix:
First Name:AISHA
Middle Name:
Last Name:DARK
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 1:6008 W THOMPSON ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19151-4436
Mailing Address - Country:US
Mailing Address - Phone:267-531-7724
Mailing Address - Fax:
Practice Address - Street 1:6008 W THOMPSON ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19151-4436
Practice Address - Country:US
Practice Address - Phone:267-531-7724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician