Healthcare Provider Details

I. General information

NPI: 1689792152
Provider Name (Legal Business Name): JON E SEELEY BS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5842 SUMPTER DR
PINSON AL
35126-3559
US

IV. Provider business mailing address

2817 30TH AVE N
BIRMINGHAM AL
35207-4541
US

V. Phone/Fax

Practice location:
  • Phone: 205-323-4548
  • Fax: 205-521-6854
Mailing address:
  • Phone: 205-323-4548
  • Fax: 205-521-6854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7084
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: