Provider Demographics
NPI:1629359559
Name:SIGMUND, NANCY ALICE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:ALICE
Last Name:SIGMUND
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 GRAVOIS BLUFFS BLVD
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-4009
Mailing Address - Country:US
Mailing Address - Phone:636-343-8402
Mailing Address - Fax:636-305-7413
Practice Address - Street 1:701 GRAVOIS BLUFFS BLVD
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-4009
Practice Address - Country:US
Practice Address - Phone:636-343-8402
Practice Address - Fax:636-305-7413
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO042451183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist