Provider Demographics
NPI:1760613566
Name:SIDES, WILLIAM B (RPH)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:B
Last Name:SIDES
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 UNION ST
Mailing Address - Street 2:
Mailing Address - City:FOXBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02035-2359
Mailing Address - Country:US
Mailing Address - Phone:508-543-6553
Mailing Address - Fax:
Practice Address - Street 1:37 UNION ST
Practice Address - Street 2:
Practice Address - City:FOXBORO
Practice Address - State:MA
Practice Address - Zip Code:02035-2359
Practice Address - Country:US
Practice Address - Phone:508-543-6553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16946183500000X
RI2408183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist