Provider Demographics
NPI:1639547797
Name:SANDIDGE, GARRETT
Entity Type:Individual
Prefix:
First Name:GARRETT
Middle Name:
Last Name:SANDIDGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:GARRETT
Other - Middle Name:GRAYSON
Other - Last Name:SANDIDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1424 CARNAHAN RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15220-4013
Mailing Address - Country:US
Mailing Address - Phone:412-443-8255
Mailing Address - Fax:
Practice Address - Street 1:2501 BANKSVILLE RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15216-2853
Practice Address - Country:US
Practice Address - Phone:412-571-2550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-07
Last Update Date:2015-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP449833183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist