Provider Demographics
NPI:1245507524
Name:SALA, MARCIN HENRYK (PHARMD)
Entity type:Individual
Prefix:
First Name:MARCIN
Middle Name:HENRYK
Last Name:SALA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10000 BUSTLETON AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-3748
Mailing Address - Country:US
Mailing Address - Phone:215-698-1878
Mailing Address - Fax:
Practice Address - Street 1:8814 BRADFORD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-5002
Practice Address - Country:US
Practice Address - Phone:215-203-6547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP445787183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP445787OtherPHARMACIST LICENCE
PARPI005518OtherAUTHORIZATION TO ADMINISTER INJECTABLES