Provider Demographics
NPI:1841898004
Name:FRUSTAGLIO, REBECCA LEE (PHARMD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LEE
Last Name:FRUSTAGLIO
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 1:115 WILMAR AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-3547
Mailing Address - Country:US
Mailing Address - Phone:308-381-0328
Mailing Address - Fax:308-381-2685
Practice Address - Street 1:115 WILMAR AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-3547
Practice Address - Country:US
Practice Address - Phone:308-381-0328
Practice Address - Fax:308-381-2685
Is Sole Proprietor?:No
Enumeration Date:2020-10-10
Last Update Date:2020-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE15324183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist