Provider Demographics
NPI:1538684782
Name:SIEFKER, CHRISTINE GAIL (PHARMD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:GAIL
Last Name:SIEFKER
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 1:3706 N KENNETH RD
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-3128
Mailing Address - Country:US
Mailing Address - Phone:937-474-1914
Mailing Address - Fax:928-681-8739
Practice Address - Street 1:3801 SANTA ROSA DR STE D
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-2311
Practice Address - Country:US
Practice Address - Phone:938-681-8738
Practice Address - Fax:928-681-8739
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-09
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH031318421835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH03131842OtherPHARMACIST LICENSE