Basic Information
| Provider Information | |||||||||
| NPI: | 1225313406 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SIERS | ||||||||
| FirstName: | JACQUELINE | ||||||||
| MiddleName: | HALLIE | ||||||||
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| Credential: | PHARM.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 152 RIDLEY CIR | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300301117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8434784273 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2175 PARKLAKE DR NE | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303452845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704967400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2011 | ||||||||
| LastUpdateDate: | 08/07/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 025664 | GA | Y | Pharmacy Service Providers | Pharmacist | 183500000X | 13070 | SC | N | Pharmacy Service Providers | Pharmacist |
No ID Information.