Provider Demographics
NPI:1447854609
Name:FAHY, GERALDINE ALICE
Entity type:Individual
Prefix:
First Name:GERALDINE
Middle Name:ALICE
Last Name:FAHY
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 1:107 MARTINS RUN
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-1023
Mailing Address - Country:US
Mailing Address - Phone:610-353-4338
Mailing Address - Fax:
Practice Address - Street 1:306 E BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-3807
Practice Address - Country:US
Practice Address - Phone:610-566-8400
Practice Address - Fax:610-627-0990
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-27
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP043917L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist