Provider Demographics
NPI:1336431766
Name:SAO, VISALSAMBATH (RPH)
Entity Type:Individual
Prefix:MR
First Name:VISALSAMBATH
Middle Name:
Last Name:SAO
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 1:309 SKYPORT RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-2300
Mailing Address - Country:US
Mailing Address - Phone:717-602-6230
Mailing Address - Fax:
Practice Address - Street 1:309 SKYPORT RD
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-2300
Practice Address - Country:US
Practice Address - Phone:717-602-6230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP044202L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist