MEDICARE: MRS. SHERYL ANNE LIEDTKE 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	033812-1	NY

General Provider Information

NPI Number	:	1730144361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHERYL ANNE LIEDTKE RPH

Provider Business Mailing Address
First Line	:	59 BOSWORTH FLD
Second Line	:
City	:	MENDON
State	:	NY
Zip	:	14506-9752
Country	:	US
Telephone Number	:	585-624-9161
Fax Number	:

Provider Business Practice Location Address
First Line	:	95 FALL ST
Second Line	:
City	:	SENECA FALLS
State	:	NY
Zip	:	13148-1408
Country	:	US
Telephone Number	:	315-568-1700
Fax Number	:	315-568-1300

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

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	07/08/2007

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