Provider Demographics
NPI:1528470101
Name:SIEUX, GEOFFREY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:
Last Name:SIEUX
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 EMERALD BAY RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-6200
Mailing Address - Country:US
Mailing Address - Phone:530-541-0613
Mailing Address - Fax:530-541-8264
Practice Address - Street 1:1040 EMERALD BAY RD
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-6200
Practice Address - Country:US
Practice Address - Phone:530-541-0613
Practice Address - Fax:530-541-8264
Is Sole Proprietor?:No
Enumeration Date:2014-05-29
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30212183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist