Provider Demographics
NPI:1629359971
Name:SYRYLO, DOUGLAS MARK (RPH)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:MARK
Last Name:SYRYLO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:494 NUTT RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-3354
Mailing Address - Country:US
Mailing Address - Phone:610-933-2798
Mailing Address - Fax:610-935-1432
Practice Address - Street 1:494 NUTT RD
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-3354
Practice Address - Country:US
Practice Address - Phone:610-933-2798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-31
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP033759L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist