Provider Demographics
NPI:1215150602
Name:SIBEUDU, NNAMDI U (RPH)
Entity type:Individual
Prefix:
First Name:NNAMDI
Middle Name:U
Last Name:SIBEUDU
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 1:803 ASHBOURNE RD
Mailing Address - Street 2:
Mailing Address - City:CHELTENHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19012-1104
Mailing Address - Country:US
Mailing Address - Phone:215-379-4343
Mailing Address - Fax:
Practice Address - Street 1:512 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:SHARON HILL
Practice Address - State:PA
Practice Address - Zip Code:19079-1014
Practice Address - Country:US
Practice Address - Phone:484-953-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP040887L183500000X
DEA10002626183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist