Healthcare Provider Details

I. General information

NPI: 1225523012
Provider Name (Legal Business Name): SETONDJI GBEGAN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2018
Last Update Date: 06/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 WILLOW LN
GREENVILLE AL
36037-9709
US

IV. Provider business mailing address

501 WILLOW LN
GREENVILLE AL
36037-9709
US

V. Phone/Fax

Practice location:
  • Phone: 334-382-7456
  • Fax:
Mailing address:
  • Phone: 334-382-7456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number20267
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: