MEDICARE: JEREMY SIEHNEL PHARM. D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	060627	NY
2	183500000X	Pharmacist	76491	CA

General Provider Information

NPI Number	:	1194109157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMY SIEHNEL PHARM. D.

Provider Business Mailing Address
First Line	:	1411 KETTNER BLVD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-2420
Country	:	US
Telephone Number	:	619-231-7405
Fax Number	:

Provider Business Practice Location Address
First Line	:	1411 KETTNER BLVD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-2420
Country	:	US
Telephone Number	:	619-231-7405
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2015
Last Update Date	:	07/09/2018

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