Provider Demographics
NPI:1477835429
Name:PHILIP, SHERLY (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:SHERLY
Middle Name:
Last Name:PHILIP
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412 PEACH TREE LN
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-0919
Mailing Address - Country:US
Mailing Address - Phone:215-605-3427
Mailing Address - Fax:
Practice Address - Street 1:1412 PEACH TREE LN
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-0919
Practice Address - Country:US
Practice Address - Phone:215-605-3427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP443276183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist