Provider Demographics
NPI:1952898579
Name:AMIDON, SETH
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:
Last Name:AMIDON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:685 ELMSPRING CT APT TB
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15220-4105
Mailing Address - Country:US
Mailing Address - Phone:585-738-0617
Mailing Address - Fax:
Practice Address - Street 1:1860 CENTRE AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15219-4369
Practice Address - Country:US
Practice Address - Phone:412-246-0963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-19
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY062928183500000X
PARP451875183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist