Provider Demographics
NPI:1689736209
Name:SIOMKA, ALEXANDER W (RPH)
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:W
Last Name:SIOMKA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5128 TYLER DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-3488
Mailing Address - Country:US
Mailing Address - Phone:248-689-4326
Mailing Address - Fax:248-689-3450
Practice Address - Street 1:6213 CHICAGO RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-1697
Practice Address - Country:US
Practice Address - Phone:586-751-7979
Practice Address - Fax:586-751-0809
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302024461183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302024461OtherPHARMASICT LICENSE NUMBER