Basic Information
| Provider Information | |||||||||
| NPI: | 1093078883 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SIEFKES | ||||||||
| FirstName: | BRIANNA | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | PHARM.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13194 397TH AVE | ||||||||
| Address2: | |||||||||
| City: | BATH | ||||||||
| State: | SD | ||||||||
| PostalCode: | 574275911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053803309 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 100 LAKE TRAVERSE DR | ||||||||
| Address2: | |||||||||
| City: | SISSETON | ||||||||
| State: | SD | ||||||||
| PostalCode: | 572627046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6057423795 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2012 | ||||||||
| LastUpdateDate: | 06/18/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 5935 | SD | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.