Provider Demographics
NPI:1992281927
Name:SEABAUGH, SHIRLEY A (RPH)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:A
Last Name:SEABAUGH
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 1:1801 MISSOURI BLVD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-1735
Mailing Address - Country:US
Mailing Address - Phone:573-635-8910
Mailing Address - Fax:
Practice Address - Street 1:1801 MISSOURI BLVD
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-1735
Practice Address - Country:US
Practice Address - Phone:573-635-8910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO029297183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist