Provider Demographics
NPI:1073982138
Name:SIEBERS, WILLAIM
Entity Type:Individual
Prefix:
First Name:WILLAIM
Middle Name:
Last Name:SIEBERS
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 1:2659 OLYMPIC ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-3473
Mailing Address - Country:US
Mailing Address - Phone:541-744-3085
Mailing Address - Fax:541-744-6677
Practice Address - Street 1:2659 OLYMPIC ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-3473
Practice Address - Country:US
Practice Address - Phone:541-744-3085
Practice Address - Fax:541-744-6677
Is Sole Proprietor?:No
Enumeration Date:2015-09-18
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR80721835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist