Provider Demographics
NPI:1750090627
Name:SIWIAK, ANTHONY DAVID
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:DAVID
Last Name:SIWIAK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 PARK WEST PL APT 105
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15205-5621
Mailing Address - Country:US
Mailing Address - Phone:724-825-1190
Mailing Address - Fax:
Practice Address - Street 1:1101 PARKWAY VIEW DR
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15205-1425
Practice Address - Country:US
Practice Address - Phone:412-697-4880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP452557183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist