Provider Demographics
NPI:1245826817
Name:BEITENMAN, REBECCA REIS (PHARMD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:REIS
Last Name:BEITENMAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 MARTIN DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68005-4764
Mailing Address - Country:US
Mailing Address - Phone:402-990-6908
Mailing Address - Fax:
Practice Address - Street 1:513 MARTIN DR
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-4764
Practice Address - Country:US
Practice Address - Phone:402-990-6908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-17
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12932183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist