Provider Demographics
NPI:1083990220
Name:SIDONE, BRIAN J (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:J
Last Name:SIDONE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 58
Mailing Address - Street 2:
Mailing Address - City:EBENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15931-0058
Mailing Address - Country:US
Mailing Address - Phone:814-472-9390
Mailing Address - Fax:814-472-1166
Practice Address - Street 1:3720 NEW GERMANY RD
Practice Address - Street 2:
Practice Address - City:EBENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15931
Practice Address - Country:US
Practice Address - Phone:814-472-9390
Practice Address - Fax:814-472-1166
Is Sole Proprietor?:No
Enumeration Date:2011-11-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA101YA0400X, 174H00000X
PARP445592183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No174H00000XOther Service ProvidersHealth Educator