Provider Demographics
NPI:1609417070
Name:SDARBOUZE APOTHECARY INC.
Entity Type:Organization
Organization Name:SDARBOUZE APOTHECARY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:IVEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:215-424-2611
Mailing Address - Street 1:5751 N BROAD ST STE 3
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141-2302
Mailing Address - Country:US
Mailing Address - Phone:215-424-2611
Mailing Address - Fax:
Practice Address - Street 1:5751 N BROAD ST STE 3
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-2302
Practice Address - Country:US
Practice Address - Phone:215-424-2611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy