Provider Demographics
NPI:1316126097
Name:SRINIVASAN, NIVEDITHA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:NIVEDITHA
Middle Name:
Last Name:SRINIVASAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 BEREHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-1836
Mailing Address - Country:US
Mailing Address - Phone:716-691-4220
Mailing Address - Fax:
Practice Address - Street 1:2561 UNION RD
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14227-4636
Practice Address - Country:US
Practice Address - Phone:716-668-6024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-30
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049957183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist