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General NPI Number Information
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NPI Number | 1134390172
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Entity Type | Organization
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Legal Business Name | SEELEY SWAN PHARMACY INC
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Dates
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Enumeration Date | 03/18/2008
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Last Update Date | 02/15/2017
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Provider Practice Location Address
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Address Line | 3027 MT HIGHWAY 83 N LAZY PINE MALL STE J
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City | SEELEY LAKE
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State | MT
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Zip | 59868-8628
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Country | US
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Telephone | 406-677-8989
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Fax | 406-677-8080
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Provider Business Mailing Address
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Address Line | PO BOX 930
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City | SEELEY LAKE
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State | MT
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Zip | 59868-0930
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Country | US
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Telephone |
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Fax | 406-677-8080
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Authorized Official
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Title or Position | OWNER
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Name | KAREN DOVE
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Credential | RPH
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Telephone | 406-677-8989
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 1251
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License Number State | MT
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