Provider Demographics
NPI:1417230343
Name:SIEGMANN, ELSIE M (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ELSIE
Middle Name:M
Last Name:SIEGMANN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2640 E SUNSHINE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2045
Mailing Address - Country:US
Mailing Address - Phone:417-885-1274
Mailing Address - Fax:417-883-7089
Practice Address - Street 1:2640 E SUNSHINE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2045
Practice Address - Country:US
Practice Address - Phone:417-885-1274
Practice Address - Fax:417-883-7089
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO042493183500000X
OK8686183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist