Healthcare Provider Details

I. General information

NPI: 1639519614
Provider Name (Legal Business Name): CHELSEA SEALEY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2013
Last Update Date: 07/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 E NIZHONI BLVD
GALLUP NM
87301-5748
US

IV. Provider business mailing address

900 BOARDMAN DR #C20
GALLUP NM
87301-4774
US

V. Phone/Fax

Practice location:
  • Phone: 505-722-1185
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number0202212212
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: