Healthcare Provider Details

I. General information

NPI: 1669527669
Provider Name (Legal Business Name): LESA SEIBEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 N MAIN ST
GREER SC
29650-1921
US

IV. Provider business mailing address

3832 HIGHWAY 414
LANDRUM SC
29356-9505
US

V. Phone/Fax

Practice location:
  • Phone: 864-877-0753
  • Fax:
Mailing address:
  • Phone: 864-895-2367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number19893
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: