Provider Demographics
NPI:1548866577
Name:STA ANA, DANA ISOBEL A (PHARMD)
Entity type:Individual
Prefix:
First Name:DANA ISOBEL
Middle Name:A
Last Name:STA ANA
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 1:3812 MARY ST
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-2720
Mailing Address - Country:US
Mailing Address - Phone:267-371-2102
Mailing Address - Fax:
Practice Address - Street 1:7520 CITY LINE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19151-2101
Practice Address - Country:US
Practice Address - Phone:215-477-8401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-06
Last Update Date:2020-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP454935183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist