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General NPI Number Information
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NPI Number | 1295286284
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Entity Type | Individual
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Provider Name | THEODORE MARTENS SIEVERS PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 10/14/2016
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Last Update Date | 10/14/2016
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Provider Practice Location Address
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Address Line | 757 WESTWOOD PLZ ROOM 8318
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City | LOS ANGELES
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State | CA
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Zip | 90095-8358
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Country | US
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Telephone | 310-267-7832
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Fax |
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Provider Business Mailing Address
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Address Line | 1010 VETERAN AVE ROOM 1232
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City | LOS ANGELES
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State | CA
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Zip | 90024-2704
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Country | US
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Telephone | 310-794-7206
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 48398
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | 48398
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License Number State | CA
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