Provider Demographics
NPI:1598988214
Name:SIEVERS, GERALD ARTHUR (BSRPH,MBA)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:ARTHUR
Last Name:SIEVERS
Suffix:
Gender:M
Credentials:BSRPH,MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 DELONG AVE
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-1735
Mailing Address - Country:US
Mailing Address - Phone:712-323-5639
Mailing Address - Fax:402-451-2401
Practice Address - Street 1:8613 N 30TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68112-1852
Practice Address - Country:US
Practice Address - Phone:402-451-2125
Practice Address - Fax:402-451-2401
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7875183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47075716455Medicaid