Healthcare Provider Details

I. General information

NPI: 1699761262
Provider Name (Legal Business Name): TIMOTHY SCOTT SEELEY R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 AVENUE H PHARMACY DEPARTMENT
POWELL WY
82435-2260
US

IV. Provider business mailing address

1118 BARROWS RD
POWELL WY
82435-9354
US

V. Phone/Fax

Practice location:
  • Phone: 307-754-1279
  • Fax: 307-754-7732
Mailing address:
  • Phone: 307-754-8018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2365
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: