Provider Demographics
NPI:1376002014
Name:SEEKINS, KATHERINE BROOKE
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:BROOKE
Last Name:SEEKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 SCARLET OAK DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-7768
Mailing Address - Country:US
Mailing Address - Phone:804-432-3990
Mailing Address - Fax:
Practice Address - Street 1:1231 S PRAIRIE AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005-2022
Practice Address - Country:US
Practice Address - Phone:719-561-4407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-12
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA.0022376183500000X
VA0202216962183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist