Provider Demographics
NPI:1255500708
Name:SEELY ENTERPRISES
Entity Type:Organization
Organization Name:SEELY ENTERPRISES
Other - Org Name:TERRELS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHCY MANG
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DOC OF PHARMACY
Authorized Official - Phone:435-462-6300
Mailing Address - Street 1:1050 S STATE ST
Mailing Address - Street 2:1050 S STATE STREET
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:UT
Mailing Address - Zip Code:84647-2206
Mailing Address - Country:US
Mailing Address - Phone:435-462-6300
Mailing Address - Fax:435-462-6301
Practice Address - Street 1:1050 S STATE ST
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:UT
Practice Address - Zip Code:84647-2206
Practice Address - Country:US
Practice Address - Phone:435-462-6300
Practice Address - Fax:435-462-6301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
UT6749847-17033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2100974OtherPK