Provider Demographics
NPI:1689917015
Name:SIDDIQUI, ERUM N (RPH)
Entity Type:Individual
Prefix:
First Name:ERUM
Middle Name:N
Last Name:SIDDIQUI
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 1:68 AMADOR ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10303-1709
Mailing Address - Country:US
Mailing Address - Phone:718-494-3430
Mailing Address - Fax:
Practice Address - Street 1:68 AMADOR ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10303-1709
Practice Address - Country:US
Practice Address - Phone:718-494-3430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-04
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057875183500000X
NJ28RI03264600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist