=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073934261
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEVEN DAVID SICHERMAN B.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/15/2013
-----------------------------------------------------
Last Update Date | 12/15/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 890 W WILLIAMS AVE
-----------------------------------------------------
City | FALLON
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89406-2652
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-428-2340
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 495 S BAILEY ST
-----------------------------------------------------
City | FALLON
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89406-3741
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-771-8319
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 7932
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------