Provider Demographics
NPI:1316556186
Name:FUDZIE, SEYRAM S
Entity Type:Individual
Prefix:
First Name:SEYRAM
Middle Name:S
Last Name:FUDZIE
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 1:276 LEIGH FARM RD APT 301
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-8134
Mailing Address - Country:US
Mailing Address - Phone:919-645-7662
Mailing Address - Fax:
Practice Address - Street 1:300 MEADOWMONT VILLAGE CIR
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-7518
Practice Address - Country:US
Practice Address - Phone:984-974-5737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-28
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC700253183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist