Provider Demographics
NPI:1871842153
Name:SEIBERT, LARECIA MARIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:LARECIA
Middle Name:MARIE
Last Name:SEIBERT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 COSHOCTON AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-1975
Mailing Address - Country:US
Mailing Address - Phone:815-757-5565
Mailing Address - Fax:
Practice Address - Street 1:40 THF BLVD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005-1150
Practice Address - Country:US
Practice Address - Phone:815-757-5565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-02
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03136363183500000X
MO2012029753183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist