Provider Demographics
NPI:1114212925
Name:THIEMAN, AYSHA CLARICE (PHARMD)
Entity Type:Individual
Prefix:
First Name:AYSHA
Middle Name:CLARICE
Last Name:THIEMAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:AYSHA
Other - Middle Name:CLARICE
Other - Last Name:MOTILLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:5775 SUNNYBROOK DR
Mailing Address - Street 2:T-1800
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-4247
Mailing Address - Country:US
Mailing Address - Phone:712-274-8854
Mailing Address - Fax:712-274-8854
Practice Address - Street 1:5775 SUNNYBROOK DR
Practice Address - Street 2:T-1800
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-4247
Practice Address - Country:US
Practice Address - Phone:712-274-8854
Practice Address - Fax:712-274-8854
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20108183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist