Provider Demographics
NPI:1396046041
Name:SIEGRIST, LUKE DANIEL
Entity Type:Individual
Prefix:DR
First Name:LUKE
Middle Name:DANIEL
Last Name:SIEGRIST
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 1:200 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-2031
Mailing Address - Country:US
Mailing Address - Phone:425-226-0325
Mailing Address - Fax:425-226-3296
Practice Address - Street 1:200 S 3RD ST
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-2031
Practice Address - Country:US
Practice Address - Phone:425-226-0325
Practice Address - Fax:425-226-3296
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-11
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60105656183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist