Amanda Siddon, PHARM.D.
Individual provider Active NPI Pharmacist · Ticonderoga, NY
NPI 1184932733 · NPPES record last updated Sep 16, 2010
Key facts
- NPI
- 1184932733
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 20055106 (NY)
- Practice address
- 1134 Wicker St
Ticonderoga, NY 12883-3103 - Phone
- (518) 585-3060
- NPI assigned
- Sep 16, 2010
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20055106 | NY | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 20055106 | NY | Yes |
Addresses
Primary practice location
1134 Wicker St
Ticonderoga, NY 12883-3103
Mailing address
955 Sheldon Rd
Fair Haven, VT 05743-9245
Other providers in Ticonderoga, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 16, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.