Provider Demographics
NPI:1598983272
Name:IBEREDEM, EMMERLYN E (RPH)
Entity Type:Individual
Prefix:
First Name:EMMERLYN
Middle Name:E
Last Name:IBEREDEM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2034 COVEY CT
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-3665
Mailing Address - Country:US
Mailing Address - Phone:717-540-8546
Mailing Address - Fax:
Practice Address - Street 1:208 N 3RD ST
Practice Address - Street 2:SUITE 120
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17101-1512
Practice Address - Country:US
Practice Address - Phone:717-232-4101
Practice Address - Fax:717-214-7696
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP033326L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist