Healthcare Provider Details

I. General information

NPI: 1376216606
Provider Name (Legal Business Name): ABIGAIL ROSE SIREK PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 09/29/2021
Certification Date: 09/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 6TH AVE N
SAINT CLOUD MN
56303-2736
US

IV. Provider business mailing address

200 W 1ST ST
PAYNESVILLE MN
56362-1445
US

V. Phone/Fax

Practice location:
  • Phone: 320-252-5131
  • Fax: 320-240-2146
Mailing address:
  • Phone: 320-243-7702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number125288
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: