Provider Demographics
NPI:1538441415
Name:SIBERT, BRUCE (RPH)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:
Last Name:SIBERT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2368 FRANKFORT AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-2466
Mailing Address - Country:US
Mailing Address - Phone:502-896-0518
Mailing Address - Fax:502-896-1179
Practice Address - Street 1:2368 FRANKFORT AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-2466
Practice Address - Country:US
Practice Address - Phone:502-896-0518
Practice Address - Fax:502-896-1179
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY008220183500000X
TN005173183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist