Provider Demographics
NPI:1972883619
Name:SEABLOOM, JEFFREY L (RPH)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:L
Last Name:SEABLOOM
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 1:421 S EISENHOWER PKWY
Mailing Address - Street 2:
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501-8361
Mailing Address - Country:US
Mailing Address - Phone:715-369-1079
Mailing Address - Fax:715-369-1108
Practice Address - Street 1:421 S EISENHOWER PKWY
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-8361
Practice Address - Country:US
Practice Address - Phone:715-369-1079
Practice Address - Fax:715-369-1108
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9809-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist