Provider Demographics
NPI:1528685195
Name:DIFEBO, SARAH M
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:M
Last Name:DIFEBO
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 1:40 COOPERTOWN RD
Mailing Address - Street 2:
Mailing Address - City:HAVERFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19041-1013
Mailing Address - Country:US
Mailing Address - Phone:570-336-6217
Mailing Address - Fax:
Practice Address - Street 1:518 PORT ROYAL AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-2144
Practice Address - Country:US
Practice Address - Phone:215-483-6680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP442900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist