Provider Demographics
NPI:1588260681
Name:SIETINS, MARY E (RPH)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:SIETINS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 MILL STREAM DR
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-5425
Mailing Address - Country:US
Mailing Address - Phone:508-272-7834
Mailing Address - Fax:
Practice Address - Street 1:1470 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:N ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02760-6745
Practice Address - Country:US
Practice Address - Phone:508-699-2007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-05
Last Update Date:2020-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH19460183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist