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General NPI Number Information
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NPI Number | 1184932733
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Entity Type | Individual
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Provider Name | AMANDA SIDDON PHARM.D.
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Gender | Female
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Dates
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Enumeration Date | 09/16/2010
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Last Update Date | 09/16/2010
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Provider Practice Location Address
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Address Line | 1134 WICKER ST
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City | TICONDEROGA
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State | NY
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Zip | 12883-3103
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Country | US
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Telephone | 518-585-3060
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Fax |
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Provider Business Mailing Address
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Address Line | 955 SHELDON RD
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City | FAIR HAVEN
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State | VT
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Zip | 05743-9245
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 20055106
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License Number State | NY
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