Healthcare Provider Details

I. General information

NPI: 1861483679
Provider Name (Legal Business Name): ERIC D SIEKKINEN R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2005
Last Update Date: 06/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 E MAIN ST
DANVILLE OH
43014-0070
US

IV. Provider business mailing address

16631 KAYLOR RD
DANVILLE OH
43014-9739
US

V. Phone/Fax

Practice location:
  • Phone: 740-599-6744
  • Fax: 740-599-6799
Mailing address:
  • Phone: 740-599-5756
  • Fax: 740-599-6799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03213181
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: