Provider Demographics
NPI:1063191500
Name:KREFT, SIERRA BROOKE (PHARMD, BCPS)
Entity type:Individual
Prefix:
First Name:SIERRA
Middle Name:BROOKE
Last Name:KREFT
Suffix:
Gender:F
Credentials:PHARMD, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7898 NORTHERN LIGHTS AVE
Mailing Address - Street 2:
Mailing Address - City:HORACE
Mailing Address - State:ND
Mailing Address - Zip Code:58047-3704
Mailing Address - Country:US
Mailing Address - Phone:701-471-2171
Mailing Address - Fax:
Practice Address - Street 1:1532 32ND AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-5987
Practice Address - Country:US
Practice Address - Phone:701-478-8155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1245001835P0018X
NDRPH61461835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist