Provider Demographics
NPI:1730144361
Name:LIEDTKE, SHERYL ANNE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:SHERYL
Middle Name:ANNE
Last Name:LIEDTKE
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 1:59 BOSWORTH FLD
Mailing Address - Street 2:
Mailing Address - City:MENDON
Mailing Address - State:NY
Mailing Address - Zip Code:14506-9752
Mailing Address - Country:US
Mailing Address - Phone:585-624-9161
Mailing Address - Fax:
Practice Address - Street 1:95 FALL ST
Practice Address - Street 2:
Practice Address - City:SENECA FALLS
Practice Address - State:NY
Practice Address - Zip Code:13148-1408
Practice Address - Country:US
Practice Address - Phone:315-568-1700
Practice Address - Fax:315-568-1300
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033812-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist