Provider Demographics
NPI:1225352107
Name:SEIDEL, CRISTINA M (RPH)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:M
Last Name:SEIDEL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:MATAMORAS
Mailing Address - State:PA
Mailing Address - Zip Code:18336-1713
Mailing Address - Country:US
Mailing Address - Phone:570-491-5702
Mailing Address - Fax:570-491-5728
Practice Address - Street 1:1025 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:MATAMORAS
Practice Address - State:PA
Practice Address - Zip Code:18336-1713
Practice Address - Country:US
Practice Address - Phone:570-491-5702
Practice Address - Fax:570-491-5728
Is Sole Proprietor?:No
Enumeration Date:2010-03-21
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047659183500000X
NJ28RI02714600183500000X
PAIM158165183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist