Provider Demographics
NPI:1801074067
Name:SHVARTZMAN, BELLA (BS)
Entity type:Individual
Prefix:MRS
First Name:BELLA
Middle Name:
Last Name:SHVARTZMAN
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 WYNLYN RD
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-1317
Mailing Address - Country:US
Mailing Address - Phone:610-649-1997
Mailing Address - Fax:
Practice Address - Street 1:7162 RIDGE AVE
Practice Address - Street 2:SUPER FRESH 70-982
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-3250
Practice Address - Country:US
Practice Address - Phone:215-508-7782
Practice Address - Fax:215-508-7785
Is Sole Proprietor?:No
Enumeration Date:2008-02-09
Last Update Date:2008-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP041267L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP041627LOtherRPH STATE LICENSE NUMBER