Provider Demographics
NPI:1205226826
Name:SIBERT, RICHARD II
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:SIBERT
Suffix:II
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 1:1350 TIMBERWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-5611
Mailing Address - Country:US
Mailing Address - Phone:434-996-9620
Mailing Address - Fax:
Practice Address - Street 1:312 CONNOR DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-5605
Practice Address - Country:US
Practice Address - Phone:434-964-0397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0230025476183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician