Provider Demographics
NPI:1861083602
Name:TRYBUS, CECELIA MARIE
Entity type:Individual
Prefix:
First Name:CECELIA
Middle Name:MARIE
Last Name:TRYBUS
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 1:1101 E HECTOR ST UNIT 124
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-2368
Mailing Address - Country:US
Mailing Address - Phone:240-310-2686
Mailing Address - Fax:
Practice Address - Street 1:701 DEKALB ST
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-3945
Practice Address - Country:US
Practice Address - Phone:610-278-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP454624183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist