Provider Demographics
NPI:1760146674
Name:SIERECKI, CARMA JEAN
Entity Type:Individual
Prefix:DR
First Name:CARMA
Middle Name:JEAN
Last Name:SIERECKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARMA
Other - Middle Name:
Other - Last Name:SIERECKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2190 TRAMORE SQ
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-5998
Mailing Address - Country:US
Mailing Address - Phone:937-902-3752
Mailing Address - Fax:
Practice Address - Street 1:4014 VENTURE CT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-9600
Practice Address - Country:US
Practice Address - Phone:614-297-8244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03441240183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist