Provider Demographics
NPI:1578971404
Name:ZIEHM, JILL
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:ZIEHM
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 1:11470 GILBERT RD
Mailing Address - Street 2:
Mailing Address - City:RILEY
Mailing Address - State:MI
Mailing Address - Zip Code:48041-3815
Mailing Address - Country:US
Mailing Address - Phone:810-388-9633
Mailing Address - Fax:810-388-9665
Practice Address - Street 1:205 S RANGE RD
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:MI
Practice Address - Zip Code:48040-2605
Practice Address - Country:US
Practice Address - Phone:810-388-9633
Practice Address - Fax:810-388-9665
Is Sole Proprietor?:No
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020326591835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy