Healthcare Provider Details

I. General information

NPI: 1639820509
Provider Name (Legal Business Name): SALLY REBECCA SEELEY PHARMD, BC-ADM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2022
Last Update Date: 10/26/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 MICHIGAN ST NE STE 200
GRAND RAPIDS MI
49503-2533
US

IV. Provider business mailing address

7620 THORNAPPLE RIVER DR SE
CALEDONIA MI
49316-9522
US

V. Phone/Fax

Practice location:
  • Phone: 616-267-8950
  • Fax:
Mailing address:
  • Phone: 616-710-2388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number5302411718
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: