Healthcare Provider Details

I. General information

NPI: 1083990220
Provider Name (Legal Business Name): BRIAN J SIDONE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3720 NEW GERMANY RD
EBENSBURG PA
15931
US

IV. Provider business mailing address

PO BOX 58
EBENSBURG PA
15931-0058
US

V. Phone/Fax

Practice location:
  • Phone: 814-472-9390
  • Fax: 814-472-1166
Mailing address:
  • Phone: 814-472-9390
  • Fax: 814-472-1166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP445592
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: