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NPI Code Detail

MEDICARE: JERI J SIAS PHARMD

MEDICARE: JERI J SIAS PHARMD
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
1183500000XPharmacist39510TX

General Provider Information

NPI Number : 1497827901
Entity Type Code : Individual
Provider Name (Legal Business Name) : JERI J SIAS PHARMD
Provider Business Mailing Address
First Line : UTEP PHARMACY PROGRAM
Second Line : 1100 N. STANTON, STE 301
City : EL PASO
State : TX
Zip : 79902-4159
Country : US
Telephone Number : 915-747-8599
Fax Number : 915-747-8521
Provider Business Practice Location Address
First Line : CLINICA CENTRO SAN VICENTE
Second Line : 8061 ALAMEDA
City : EL PASO
State : TX
Zip : 79915-4705
Country : US
Telephone Number : 915-859-7545
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/14/2006
Last Update Date : 07/08/2007

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