Provider Demographics
NPI:1194006544
Name:SIEBERT, JAMES D (RPH)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:D
Last Name:SIEBERT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11316 W VALLEY HI DR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67209-1041
Mailing Address - Country:US
Mailing Address - Phone:316-440-3773
Mailing Address - Fax:
Practice Address - Street 1:3150 S SENECA ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67217-3235
Practice Address - Country:US
Practice Address - Phone:316-555-4789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-09215183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist