Provider Demographics
NPI:1184023442
Name:SEYMOUR, PHILLIP (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:
Last Name:SEYMOUR
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 SHERMAN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-2425
Mailing Address - Country:US
Mailing Address - Phone:651-468-0604
Mailing Address - Fax:651-468-0606
Practice Address - Street 1:360 SHERMAN ST STE 100
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2425
Practice Address - Country:US
Practice Address - Phone:651-468-0604
Practice Address - Fax:651-468-0606
Is Sole Proprietor?:No
Enumeration Date:2014-08-22
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN121992183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist