Healthcare Provider Details

I. General information

NPI: 1164733721
Provider Name (Legal Business Name): SELAD CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2010
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2046 BLACK RIVER ST STE 2
DECKERVILLE MI
48427-9448
US

IV. Provider business mailing address

2046 BLACK RIVER ST
DECKERVILLE MI
48427-9448
US

V. Phone/Fax

Practice location:
  • Phone: 810-376-8070
  • Fax: 810-376-8171
Mailing address:
  • Phone: 810-376-8070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301009445
License Number StateMI

VIII. Authorized Official

Name: ANGELA MCCONNACHIE
Title or Position: CO-CEO
Credential:
Phone: 989-635-4000