Provider Demographics
NPI:1538213921
Name:SIDOTI, CONRAD JOSEPH (REGISTERED PHARMACIS)
Entity type:Individual
Prefix:MR
First Name:CONRAD
Middle Name:JOSEPH
Last Name:SIDOTI
Suffix:
Gender:M
Credentials:REGISTERED PHARMACIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:877 HUGUENOT AVE
Mailing Address - Street 2:HUGUENOT PHARMACY
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312
Mailing Address - Country:US
Mailing Address - Phone:718-984-0477
Mailing Address - Fax:718-605-4158
Practice Address - Street 1:877 HUGUENOT AVE
Practice Address - Street 2:HUGUENOT PHARMACY
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312
Practice Address - Country:US
Practice Address - Phone:718-984-0477
Practice Address - Fax:718-605-4158
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY28026183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist