Provider Demographics
NPI:1538584164
Name:SIRI, MARK (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:SIRI
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 1:2601 HILLTOP DR
Mailing Address - Street 2:APT #628
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94806-5783
Mailing Address - Country:US
Mailing Address - Phone:510-219-1320
Mailing Address - Fax:
Practice Address - Street 1:3416 DEER VALLEY RD
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-6650
Practice Address - Country:US
Practice Address - Phone:925-978-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69750183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist