Healthcare Provider Details

I. General information

NPI: 1134390172
Provider Name (Legal Business Name): SEELEY SWAN PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2008
Last Update Date: 02/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3027 MT HIGHWAY 83 N LAZY PINE MALL STE J
SEELEY LAKE MT
59868-8628
US

IV. Provider business mailing address

PO BOX 930
SEELEY LAKE MT
59868-0930
US

V. Phone/Fax

Practice location:
  • Phone: 406-677-8989
  • Fax: 406-677-8080
Mailing address:
  • Phone:
  • Fax: 406-677-8080

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 Number1251
License Number StateMT

VIII. Authorized Official

Name: KAREN DOVE
Title or Position: OWNER
Credential: RPH
Phone: 406-677-8989