MEDICARE: JENNIFER A SIEFERT RPH

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	051036576	IL

General Provider Information

NPI Number	:	1346228418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER A SIEFERT RPH

Provider Business Mailing Address
First Line	:	4450 N PROSPECT RD STE 7
Second Line	:
City	:	PEORIA HEIGHTS
State	:	IL
Zip	:	61616-6578
Country	:	US
Telephone Number	:	309-679-2047
Fax Number	:	309-679-2051

Provider Business Practice Location Address
First Line	:	4450 N PROSPECT RD STE 7
Second Line	:
City	:	PEORIA HEIGHTS
State	:	IL
Zip	:	61616-6578
Country	:	US
Telephone Number	:	309-679-2047
Fax Number	:	309-679-2051

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

Provider Enumeration Date	:	01/09/2006
Last Update Date	:	11/21/2014

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