Provider Demographics
NPI:1982985487
Name:SIEMSEN, KATHLEEN T (RPH)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:T
Last Name:SIEMSEN
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 1:1341 HERON DR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:IL
Mailing Address - Zip Code:60002-2703
Mailing Address - Country:US
Mailing Address - Phone:847-395-9338
Mailing Address - Fax:
Practice Address - Street 1:1130 MAIN ST
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:IL
Practice Address - Zip Code:60002-1808
Practice Address - Country:US
Practice Address - Phone:847-395-0337
Practice Address - Fax:847-395-2733
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051037992183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist