Provider Demographics
NPI:1659498723
Name:SIDEL, SUSAN H (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:H
Last Name:SIDEL
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 BLUEBERRY DR
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-2614
Mailing Address - Country:US
Mailing Address - Phone:401-884-1899
Mailing Address - Fax:
Practice Address - Street 1:1193 BOSTON NECK RD
Practice Address - Street 2:
Practice Address - City:NARRAGANSETT
Practice Address - State:RI
Practice Address - Zip Code:02882-1705
Practice Address - Country:US
Practice Address - Phone:401-789-5037
Practice Address - Fax:401-789-5249
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI01614183500000X
MA21598183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist