Provider Demographics
NPI:1790121630
Name:SIAU, SIOK-HIOK
Entity Type:Individual
Prefix:
First Name:SIOK-HIOK
Middle Name:
Last Name:SIAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-4938
Mailing Address - Country:US
Mailing Address - Phone:262-338-0222
Mailing Address - Fax:262-338-3505
Practice Address - Street 1:1710 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-4938
Practice Address - Country:US
Practice Address - Phone:262-338-0222
Practice Address - Fax:262-338-3505
Is Sole Proprietor?:No
Enumeration Date:2013-05-20
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10708-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist