=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134441561
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PETER JOSEPH GIDARO R.PH.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2010
-----------------------------------------------------
Last Update Date | 02/26/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2660 CONSTITUTION BLVD
-----------------------------------------------------
City | BEAVER FALLS
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15010-1276
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-843-9350
-----------------------------------------------------
Fax | 724-847-3082
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2660 CONSTITUTION BLVD
-----------------------------------------------------
City | BEAVER FALLS
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15010-1276
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-843-9350
-----------------------------------------------------
Fax | 724-847-3082
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RP033553L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------