Provider Demographics
NPI:1093078883
Name:SIEFKES, BRIANNA K (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:K
Last Name:SIEFKES
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 1:13194 397TH AVE
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:SD
Mailing Address - Zip Code:57427-5911
Mailing Address - Country:US
Mailing Address - Phone:605-380-3309
Mailing Address - Fax:
Practice Address - Street 1:100 LAKE TRAVERSE DR
Practice Address - Street 2:
Practice Address - City:SISSETON
Practice Address - State:SD
Practice Address - Zip Code:57262-7046
Practice Address - Country:US
Practice Address - Phone:605-742-3795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD5935183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist