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General NPI Number Information
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NPI Number | 1750335790
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Entity Type | Organization
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Legal Business Name | SEAGATE HEALTH ENTERPRISES INC.
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Dates
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Enumeration Date | 05/22/2006
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Last Update Date | 09/18/2014
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Provider Practice Location Address
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Address Line | 1360 W 6TH ST SUITE 115
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City | SAN PEDRO
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State | CA
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Zip | 90732-3514
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Country | US
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Telephone | 310-831-0155
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Fax | 310-831-6654
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Provider Business Mailing Address
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Address Line | 1360 W 6TH ST SUITE 115
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City | SAN PEDRO
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State | CA
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Zip | 90732-3514
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Country | US
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Telephone | 310-831-0155
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Fax | 310-831-6654
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | MR. VISHAL PATEL
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Credential | PHARMD
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Telephone | 310-831-0155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | PHY51898
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License Number State | CA
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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 | PHY51898
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License Number State | CA
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