Healthcare Provider Details

I. General information

NPI: 1093325565
Provider Name (Legal Business Name): SETH JAMES SEAGLE PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2020
Last Update Date: 08/08/2020
Certification Date: 08/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 LAWNDALE DR
GREENSBORO NC
27408-4820
US

IV. Provider business mailing address

2701 LAWNDALE DR
GREENSBORO NC
27408-4820
US

V. Phone/Fax

Practice location:
  • Phone: 336-286-1273
  • Fax: 336-252-5752
Mailing address:
  • Phone: 336-286-1273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number29433
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: