Provider Demographics
NPI:1962628701
Name:SIEVERS, KEITH A (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:A
Last Name:SIEVERS
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7619 N DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-5613
Mailing Address - Country:US
Mailing Address - Phone:509-466-3315
Mailing Address - Fax:
Practice Address - Street 1:7619 N DIVISION ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-5613
Practice Address - Country:US
Practice Address - Phone:509-466-3315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00057351183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist