Healthcare Provider Details

I. General information

NPI: 1972160901
Provider Name (Legal Business Name): JODY SIEGRIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2019
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2209 E 32ND ST
TACOMA WA
98404-4922
US

IV. Provider business mailing address

2209 E 32ND ST
TACOMA WA
98404-4922
US

V. Phone/Fax

Practice location:
  • Phone: 253-593-0232
  • Fax: 253-593-0233
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number23394
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License NumberPH61045127
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: