Provider Demographics
NPI:1851369995
Name:SIDERITS, THOMAS V (RPH)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:V
Last Name:SIDERITS
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 1:2830 GARFIELD RD
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-9494
Mailing Address - Country:US
Mailing Address - Phone:716-483-3349
Mailing Address - Fax:
Practice Address - Street 1:811 N MAIN ST
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-3550
Practice Address - Country:US
Practice Address - Phone:716-487-0102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046722183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist