Provider Demographics
NPI:1528420494
Name:SIDICK, ALEKSANDRA
Entity type:Individual
Prefix:
First Name:ALEKSANDRA
Middle Name:
Last Name:SIDICK
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 1:935 BEAVER GRADE RD
Mailing Address - Street 2:
Mailing Address - City:MOON TWP
Mailing Address - State:PA
Mailing Address - Zip Code:15108-2747
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:935 BEAVER GRADE RD
Practice Address - Street 2:
Practice Address - City:MOON TWP
Practice Address - State:PA
Practice Address - Zip Code:15108-2747
Practice Address - Country:US
Practice Address - Phone:412-264-2230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP446428183500000X
OH03331493183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist