Provider Demographics
NPI:1215590302
Name:LEVULIS, SETH H (PHARMD)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:H
Last Name:LEVULIS
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 1:2514 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80504-9740
Mailing Address - Country:US
Mailing Address - Phone:303-774-9419
Mailing Address - Fax:
Practice Address - Street 1:2514 MAIN ST
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80504-9740
Practice Address - Country:US
Practice Address - Phone:303-774-9419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-15
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20933183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO20933OtherCOLORADO STATE BOARD OF PHARMACY