Provider Demographics
NPI:1861483679
Name:SIEKKINEN, ERIC D (RPH)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:D
Last Name:SIEKKINEN
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 1:16631 KAYLOR RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43014-9739
Mailing Address - Country:US
Mailing Address - Phone:740-599-5756
Mailing Address - Fax:740-599-6799
Practice Address - Street 1:10 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:OH
Practice Address - Zip Code:43014-0070
Practice Address - Country:US
Practice Address - Phone:740-599-6744
Practice Address - Fax:740-599-6799
Is Sole Proprietor?:No
Enumeration Date:2005-11-01
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03213181183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH03-2-13181OtherPHARMACIST IDENTIFICATION