Provider Demographics
NPI:1336203181
Name:SIEGRIST, JEAN EVANS (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:EVANS
Last Name:SIEGRIST
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:13865-1209
Mailing Address - Country:US
Mailing Address - Phone:607-775-3485
Mailing Address - Fax:
Practice Address - Street 1:208 NORTH RD
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:13865-1209
Practice Address - Country:US
Practice Address - Phone:607-775-3485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033559-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist