Provider Demographics
NPI:1518378264
Name:SIU, TAMIKO
Entity Type:Individual
Prefix:
First Name:TAMIKO
Middle Name:
Last Name:SIU
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 1:1039 SUNRISE AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-7008
Mailing Address - Country:US
Mailing Address - Phone:916-786-6104
Mailing Address - Fax:916-786-8240
Practice Address - Street 1:1039 SUNRISE AVE
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-7008
Practice Address - Country:US
Practice Address - Phone:916-786-6104
Practice Address - Fax:916-786-8240
Is Sole Proprietor?:No
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39423183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist