Provider Demographics
NPI:1962723346
Name:DERRY, SADIE MAHALIA (PHARMD)
Entity type:Individual
Prefix:
First Name:SADIE
Middle Name:MAHALIA
Last Name:DERRY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:389 OLD CLAIRTON RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILLS
Mailing Address - State:PA
Mailing Address - Zip Code:15236-4334
Mailing Address - Country:US
Mailing Address - Phone:412-653-4102
Mailing Address - Fax:
Practice Address - Street 1:389 OLD CLAIRTON RD
Practice Address - Street 2:
Practice Address - City:PLEASANT HILLS
Practice Address - State:PA
Practice Address - Zip Code:15236-4334
Practice Address - Country:US
Practice Address - Phone:412-653-4102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-19
Last Update Date:2010-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP438611183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist