Provider Demographics
NPI:1841674462
Name:SIEGENTHALER, ERICK (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ERICK
Middle Name:
Last Name:SIEGENTHALER
Suffix:
Gender:M
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:N8898 BLUE VISTA LN
Mailing Address - Street 2:
Mailing Address - City:NEW GLARUS
Mailing Address - State:WI
Mailing Address - Zip Code:53574-8819
Mailing Address - Country:US
Mailing Address - Phone:608-214-1059
Mailing Address - Fax:
Practice Address - Street 1:N8898 BLUE VISTA LN
Practice Address - Street 2:
Practice Address - City:NEW GLARUS
Practice Address - State:WI
Practice Address - Zip Code:53574-8819
Practice Address - Country:US
Practice Address - Phone:608-214-1059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-14
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17956-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist