MEDICARE: JACQUELINE SIEBENTHAL 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	41282	CA

General Provider Information

NPI Number	:	1831474055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE SIEBENTHAL RPH

Provider Business Mailing Address
First Line	:	1574 E VALLEY PKWY
Second Line	:
City	:	ESCONDIDO
State	:	CA
Zip	:	92027-2316
Country	:	US
Telephone Number	:	760-839-7932
Fax Number	:	760-839-7978

Provider Business Practice Location Address
First Line	:	1574 E VALLEY PKWY
Second Line	:
City	:	ESCONDIDO
State	:	CA
Zip	:	92027-2316
Country	:	US
Telephone Number	:	760-839-7932
Fax Number	:	760-839-7978

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

Provider Enumeration Date	:	10/19/2011
Last Update Date	:	10/19/2011

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