Provider Demographics
NPI:1467894337
Name:SEEGER, RICHARD WALTER (RPH)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:WALTER
Last Name:SEEGER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 BOTTINEAU AVE NW
Mailing Address - Street 2:
Mailing Address - City:RED LAKE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56750-4101
Mailing Address - Country:US
Mailing Address - Phone:218-253-4471
Mailing Address - Fax:
Practice Address - Street 1:105 INTERNATIONAL DR
Practice Address - Street 2:
Practice Address - City:RED LAKE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56750-4665
Practice Address - Country:US
Practice Address - Phone:218-253-3480
Practice Address - Fax:218-253-3425
Is Sole Proprietor?:No
Enumeration Date:2013-07-22
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN113136183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN113136OtherMN PHARMACY LICENSE NUMBER