1154640738 NPI number — DR. PHILLIP DAVID SEBRELL PHARMD

Table of content: DR. PHILLIP DAVID SEBRELL PHARMD (NPI 1154640738)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154640738 NPI number — DR. PHILLIP DAVID SEBRELL PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEBRELL
Provider First Name:
PHILLIP
Provider Middle Name:
DAVID
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154640738
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/16/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
191 MASTERS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POTTSTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19464-3493
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-715-8242
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
180 UPLAND SQ DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STOWE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19464-9432
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-970-0004
Provider Business Practice Location Address Fax Number:
610-970-0007
Provider Enumeration Date:
05/22/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  RP438886 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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