Provider Demographics
NPI:1124348131
Name:SIUDELA, IVONNA MARIA (RPH)
Entity type:Individual
Prefix:
First Name:IVONNA
Middle Name:MARIA
Last Name:SIUDELA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 VALLEYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MC DONALD
Mailing Address - State:PA
Mailing Address - Zip Code:15057-2620
Mailing Address - Country:US
Mailing Address - Phone:412-257-3007
Mailing Address - Fax:
Practice Address - Street 1:417 CHARTIERS ST
Practice Address - Street 2:
Practice Address - City:BRIDGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15017-2033
Practice Address - Country:US
Practice Address - Phone:412-221-8184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP034903L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist