Provider Demographics
NPI:1821329905
Name:TRIVEDI, SONAL D (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:SONAL
Middle Name:D
Last Name:TRIVEDI
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:SONAL
Other - Middle Name:D
Other - Last Name:TRIVEDI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BS PHARMACY
Mailing Address - Street 1:55 WILLEY AVE
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:NY
Mailing Address - Zip Code:12754-1611
Mailing Address - Country:US
Mailing Address - Phone:845-292-5020
Mailing Address - Fax:
Practice Address - Street 1:267 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:NY
Practice Address - Zip Code:12754-1850
Practice Address - Country:US
Practice Address - Phone:845-295-5456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-29
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040408183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY040408OtherNY STATE PHARMACIST LIC #