Provider Demographics
NPI:1790093060
Name:SIDDICK, KANWAL SONIA (PHARM D)
Entity Type:Individual
Prefix:
First Name:KANWAL
Middle Name:SONIA
Last Name:SIDDICK
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38000 HIGHWAY 3089
Mailing Address - Street 2:
Mailing Address - City:DONALDSONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70346-8596
Mailing Address - Country:US
Mailing Address - Phone:225-473-3918
Mailing Address - Fax:225-473-6115
Practice Address - Street 1:38000 HIGHWAY 3089
Practice Address - Street 2:
Practice Address - City:DONALDSONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70346-8596
Practice Address - Country:US
Practice Address - Phone:225-473-3918
Practice Address - Fax:225-473-6115
Is Sole Proprietor?:No
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA19252183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist