Provider Demographics
NPI:1386216141
Name:SHARMA, SIDDHANT (PHARMD)
Entity Type:Individual
Prefix:
First Name:SIDDHANT
Middle Name:
Last Name:SHARMA
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 1:8707 258TH ST
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-1419
Mailing Address - Country:US
Mailing Address - Phone:516-301-7149
Mailing Address - Fax:
Practice Address - Street 1:30 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8301
Practice Address - Country:US
Practice Address - Phone:516-301-7149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY066737183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist