Provider Demographics
NPI:1710269485
Name:REALSEN, REBECCA SUSAN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:SUSAN
Last Name:REALSEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10794 VISTA RD
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-3130
Mailing Address - Country:US
Mailing Address - Phone:303-204-5845
Mailing Address - Fax:
Practice Address - Street 1:10794 VISTA RD
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-3130
Practice Address - Country:US
Practice Address - Phone:303-204-5845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15501183500000X
AZ8827183500000X
WA00022162183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist