=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689792152
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JON E SEELEY BS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5842 SUMPTER DR
-----------------------------------------------------
City | PINSON
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35126-3559
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-323-4548
-----------------------------------------------------
Fax | 205-521-6854
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2817 30TH AVE N
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35207-4541
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-323-4548
-----------------------------------------------------
Fax | 205-521-6854
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 7084
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------