Provider Demographics
NPI:1568206613
Name:DOHERTY, NATALIA WESLEY
Entity type:Individual
Prefix:
First Name:NATALIA
Middle Name:WESLEY
Last Name:DOHERTY
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 1:505 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SHARON HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19079-1014
Mailing Address - Country:US
Mailing Address - Phone:855-494-3121
Mailing Address - Fax:
Practice Address - Street 1:505 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:855-494-3121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP440450183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist