Provider Demographics
NPI:1073553889
Name:SEYOUR, KELLY
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:SEYOUR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 CARMEL RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-3120
Mailing Address - Country:US
Mailing Address - Phone:336-288-9631
Mailing Address - Fax:
Practice Address - Street 1:803 FRIENDLY CENTER RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-2024
Practice Address - Country:US
Practice Address - Phone:336-292-6888
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8452183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist