Healthcare Provider Details

I. General information

NPI: 1639734346
Provider Name (Legal Business Name): SEWARD PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2019
Last Update Date: 05/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2209 E LAKE ST
MINNEAPOLIS MN
55407-4563
US

IV. Provider business mailing address

1014 E 36TH ST
MINNEAPOLIS MN
55407-2632
US

V. Phone/Fax

Practice location:
  • Phone: 770-312-9429
  • Fax:
Mailing address:
  • Phone: 770-312-9429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ELIAS USSO
Title or Position: PHARMACIST-IN-CHARGE
Credential: PHARMD
Phone: 770-312-9429