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General NPI Number Information
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NPI Number | 1508959297
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Entity Type | Organization
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Legal Business Name | SETON PHARMACY INC
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 05/12/2009
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Provider Practice Location Address
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Address Line | 2300 PARK AVENUE SUITE 100
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City | ORANGE PARK
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State | FL
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Zip | 32073-5572
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Country | US
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Telephone | 904-215-2780
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Fax | 904-278-8641
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Provider Business Mailing Address
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Address Line | 2300 PARK AVENUE SUITE 100
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City | ORANGE PARK
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State | FL
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Zip | 32073-5572
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Country | US
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Telephone | 904-215-2780
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Fax | 904-278-8641
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Authorized Official
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Title or Position | CEO
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Name | SCOTT WHALEN
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Credential | PHD
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Telephone | 904-308-8446
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH-0017632
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License Number State | FL
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