Provider Demographics
NPI:1982364964
Name:SIDDIG, YUSRA K
Entity type:Individual
Prefix:
First Name:YUSRA
Middle Name:K
Last Name:SIDDIG
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 1:3860 CLARERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-3375
Mailing Address - Country:US
Mailing Address - Phone:571-361-0519
Mailing Address - Fax:
Practice Address - Street 1:3860 CLARERIDGE DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3375
Practice Address - Country:US
Practice Address - Phone:571-361-0519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-18
Last Update Date:2021-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH034414351835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care