Healthcare Provider Details

I. General information

NPI: 1497827901
Provider Name (Legal Business Name): JERI J SIAS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CLINICA CENTRO SAN VICENTE 8061 ALAMEDA
EL PASO TX
79915-4705
US

IV. Provider business mailing address

UTEP PHARMACY PROGRAM 1100 N. STANTON, STE 301
EL PASO TX
79902-4159
US

V. Phone/Fax

Practice location:
  • Phone: 915-859-7545
  • Fax:
Mailing address:
  • Phone: 915-747-8599
  • Fax: 915-747-8521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number39510
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: