MEDICARE: DR. HANIFF SEALY PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RP00008282	NM

General Provider Information

NPI Number	:	1457758385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HANIFF SEALY PHARMD

Provider Business Mailing Address
First Line	:	815 E FLORIDA ST APT 10
Second Line	:
City	:	DEMING
State	:	NM
Zip	:	88030-5366
Country	:	US
Telephone Number	:	240-234-2783
Fax Number	:

Provider Business Practice Location Address
First Line	:	1021 E PINE ST
Second Line	:
City	:	DEMING
State	:	NM
Zip	:	88030-7009
Country	:	US
Telephone Number	:	575-546-6746
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2014
Last Update Date	:	11/20/2014

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