Provider Demographics
NPI:1134309248
Name:SEEGOLAM, SEERAM (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:SEERAM
Middle Name:
Last Name:SEEGOLAM
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13327 123RD ST
Mailing Address - Street 2:SOUTH OZONE PARK
Mailing Address - City:SOUTH OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11420-3216
Mailing Address - Country:US
Mailing Address - Phone:718-529-4979
Mailing Address - Fax:
Practice Address - Street 1:13327 123RD ST
Practice Address - Street 2:SOUTH OZONE PARK
Practice Address - City:SOUTH OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11420-3216
Practice Address - Country:US
Practice Address - Phone:718-529-4979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049085-011835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy