Provider Demographics
NPI:1568832764
Name:REALSEN, RICK WILLIAM (RPH)
Entity Type:Individual
Prefix:
First Name:RICK
Middle Name:WILLIAM
Last Name:REALSEN
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 1:2153 BIBLES HILL DR
Mailing Address - Street 2:
Mailing Address - City:FRANKTOWN
Mailing Address - State:CO
Mailing Address - Zip Code:80116-9483
Mailing Address - Country:US
Mailing Address - Phone:303-660-5590
Mailing Address - Fax:
Practice Address - Street 1:2153 BIBLES HILL DR
Practice Address - Street 2:
Practice Address - City:FRANKTOWN
Practice Address - State:CO
Practice Address - Zip Code:80116-9483
Practice Address - Country:US
Practice Address - Phone:303-660-5590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-30
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO16748183500000X
AZ7917183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist