Provider Demographics
NPI:1497827901
Name:SIAS, JERI J (PHARMD)
Entity Type:Individual
Prefix:
First Name:JERI
Middle Name:J
Last Name:SIAS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UTEP PHARMACY PROGRAM
Mailing Address - Street 2:1100 N. STANTON, STE 301
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-4159
Mailing Address - Country:US
Mailing Address - Phone:915-747-8599
Mailing Address - Fax:915-747-8521
Practice Address - Street 1:CLINICA CENTRO SAN VICENTE
Practice Address - Street 2:8061 ALAMEDA
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79915-4705
Practice Address - Country:US
Practice Address - Phone:915-859-7545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39510183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist