Provider Demographics
NPI:1609093574
Name:FISH, SIDNEY - (SIDNEY FISH)
Entity Type:Individual
Prefix:MR
First Name:SIDNEY
Middle Name:-
Last Name:FISH
Suffix:
Gender:M
Credentials:SIDNEY FISH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 BRENRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051-1378
Mailing Address - Country:US
Mailing Address - Phone:716-688-4323
Mailing Address - Fax:716-688-4323
Practice Address - Street 1:47 BRENRIDGE DR
Practice Address - Street 2:
Practice Address - City:EAST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14051-1378
Practice Address - Country:US
Practice Address - Phone:716-688-4323
Practice Address - Fax:716-688-4323
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022462-11835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy