Provider Demographics
NPI:1336379312
Name:RICHBERG, NANCIE M
Entity type:Individual
Prefix:
First Name:NANCIE
Middle Name:M
Last Name:RICHBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2385 W CHELTENHAM AVE
Mailing Address - Street 2:SUITE 42
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19150-1506
Mailing Address - Country:US
Mailing Address - Phone:267-628-3281
Mailing Address - Fax:267-628-3281
Practice Address - Street 1:2385 W CHELTENHAM AVE
Practice Address - Street 2:SUITE 42
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19150-1506
Practice Address - Country:US
Practice Address - Phone:267-628-3281
Practice Address - Fax:267-628-3281
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-23
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP039965L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist