Provider Demographics
NPI:1952682577
Name:SIEWERT, REBECCA E (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:E
Last Name:SIEWERT
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 W SAND LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-7629
Mailing Address - Country:US
Mailing Address - Phone:407-856-1809
Mailing Address - Fax:407-240-4217
Practice Address - Street 1:1835 W SAND LAKE RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-7629
Practice Address - Country:US
Practice Address - Phone:407-856-1809
Practice Address - Fax:407-240-4217
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS45114183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist