Provider Demographics
NPI:1053755363
Name:SEAMAN, REBECCA ANNE
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:ANNE
Last Name:SEAMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:REBECCA
Other - Middle Name:ANNE
Other - Last Name:SHIELDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:7290 W US HIGHWAY 50
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CO
Mailing Address - Zip Code:81201-9340
Mailing Address - Country:US
Mailing Address - Phone:719-398-6550
Mailing Address - Fax:719-698-6560
Practice Address - Street 1:415 US HWY 24 N
Practice Address - Street 2:
Practice Address - City:BUENA VISTA
Practice Address - State:CO
Practice Address - Zip Code:81211-2121
Practice Address - Country:US
Practice Address - Phone:719-398-6550
Practice Address - Fax:719-398-6560
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-18
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1680000215333600000X
CO18312183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000184069Medicaid