Provider Demographics
NPI:1811316631
Name:SIUDYLA LAVERICK, JOANN
Entity type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:SIUDYLA LAVERICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 NOBLESTOWN RD.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CARNEGIE
Mailing Address - State:PA
Mailing Address - Zip Code:15106
Mailing Address - Country:US
Mailing Address - Phone:412-325-6600
Mailing Address - Fax:
Practice Address - Street 1:500 NOBLESTOWN RD.
Practice Address - Street 2:SUITE 200
Practice Address - City:CARNEGIE
Practice Address - State:PA
Practice Address - Zip Code:15106
Practice Address - Country:US
Practice Address - Phone:412-325-6600
Practice Address - Fax:412-325-6505
Is Sole Proprietor?:No
Enumeration Date:2014-04-09
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP029678L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP029678LOtherRPH LICENSE #