Healthcare Provider Details

I. General information

NPI: 1851369995
Provider Name (Legal Business Name): THOMAS V SIDERITS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 N MAIN ST
JAMESTOWN NY
14701-3550
US

IV. Provider business mailing address

2830 GARFIELD RD
JAMESTOWN NY
14701-9494
US

V. Phone/Fax

Practice location:
  • Phone: 716-487-0102
  • Fax:
Mailing address:
  • Phone: 716-483-3349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number046722
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: