Provider Demographics
NPI:1669451068
Name:SIEBIGTEROTH, PHILIP J (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:J
Last Name:SIEBIGTEROTH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1198 VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:MACKINAW CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49701-9749
Mailing Address - Country:US
Mailing Address - Phone:906-298-2222
Mailing Address - Fax:
Practice Address - Street 1:200 WEST HOSPITAL DRIVE
Practice Address - Street 2:BOX 860
Practice Address - City:WHITERIVER
Practice Address - State:AZ
Practice Address - Zip Code:85941
Practice Address - Country:US
Practice Address - Phone:928-338-3624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302032034183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist