Provider Demographics
NPI:1639449713
Name:SIEBELS, MOLLIE ELIZABETH (PHARMD)
Entity Type:Individual
Prefix:
First Name:MOLLIE
Middle Name:ELIZABETH
Last Name:SIEBELS
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 1:525 BRANDILYNN BLVD
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-7415
Mailing Address - Country:US
Mailing Address - Phone:319-277-7793
Mailing Address - Fax:319-277-6665
Practice Address - Street 1:617 8TH AVE SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52401-2117
Practice Address - Country:US
Practice Address - Phone:319-364-4181
Practice Address - Fax:319-363-5448
Is Sole Proprietor?:No
Enumeration Date:2012-01-06
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20214183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA137463Medicaid