Healthcare Provider Details

I. General information

NPI: 1710072855
Provider Name (Legal Business Name): SEAGROVE DRUG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 NORTH FAYETTEVILLE STREET
ASHEBORO NC
27203-4642
US

IV. Provider business mailing address

900 NORTH FAYETTEVILLE STREET
ASHEBORO NC
27203-4642
US

V. Phone/Fax

Practice location:
  • Phone: 336-626-3555
  • Fax: 336-625-2355
Mailing address:
  • Phone: 336-626-3555
  • Fax: 336-625-2355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number00167
License Number StateNC

VIII. Authorized Official

Name: MR. LEON STANLEY HAYWOOD
Title or Position: CEO
Credential: RPH
Phone: 336-626-3555