MEDICARE: MRS. SAMIA JOSEPH SIDRAK RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	6533	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295002871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SAMIA JOSEPH SIDRAK RPH

Provider Business Mailing Address
First Line	:	1145 BLACKHEATH CT
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29575-5820
Country	:	US
Telephone Number	:	843-293-9571
Fax Number	:

Provider Business Practice Location Address
First Line	:	5020 DICK POND RD
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-6814
Country	:	US
Telephone Number	:	843-293-6664
Fax Number	:	843-293-6856

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/25/2011
Last Update Date	:	11/25/2011

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