Healthcare Provider Details

I. General information

NPI: 1912290685
Provider Name (Legal Business Name): SEALE HARRIS CLINIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2011
Last Update Date: 07/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 SAINT VINCENTS DR STE 520
BIRMINGHAM AL
35205-1636
US

IV. Provider business mailing address

805 SAINT VINCENTS DR SUITE 520
BIRMINGHAM AL
35205-1636
US

V. Phone/Fax

Practice location:
  • Phone: 205-769-3770
  • Fax: 205-745-4505
Mailing address:
  • Phone: 205-769-3770
  • Fax: 205-745-4505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number113722
License Number StateAL

VIII. Authorized Official

Name: MELISSA BENTLEY
Title or Position: CONSULTANT PHARMACIST
Credential:
Phone: 205-769-3779