Provider Demographics
NPI:1467178913
Name:KIERKLA, SYLVIA ANGELIKA
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:ANGELIKA
Last Name:KIERKLA
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 1:970 SAINT JAMES AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-2800
Mailing Address - Country:US
Mailing Address - Phone:413-737-6347
Mailing Address - Fax:
Practice Address - Street 1:970 SAINT JAMES AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-2800
Practice Address - Country:US
Practice Address - Phone:413-797-6347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH241129183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist