Provider Demographics
NPI:1437657269
Name:AKWIEMBI, SIRI K
Entity Type:Individual
Prefix:
First Name:SIRI
Middle Name:K
Last Name:AKWIEMBI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 W CHERRY LN APT 168
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-8891
Mailing Address - Country:US
Mailing Address - Phone:843-539-6126
Mailing Address - Fax:
Practice Address - Street 1:801 N CANAL ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-5107
Practice Address - Country:US
Practice Address - Phone:575-941-0250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-26
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00009413183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist