=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598236168
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SENECARE,LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/07/2018
-----------------------------------------------------
Last Update Date | 12/07/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 116 S WASHINGTON ST STE B
-----------------------------------------------------
City | TIFFIN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44883-2840
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 567-220-7207
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 116 S WASHINGTON ST STE B
-----------------------------------------------------
City | TIFFIN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44883-2840
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 567-220-7207
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. KENT ALLEN ZELLNER
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 567-220-7207
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------