Provider Demographics
NPI:1336144062
Name:SEOLDO, NATHALIE RENEE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NATHALIE
Middle Name:RENEE
Last Name:SEOLDO
Suffix:
Gender:F
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:PO BOX 3546
Mailing Address - Street 2:
Mailing Address - City:CHINLE
Mailing Address - State:AZ
Mailing Address - Zip Code:86503-3546
Mailing Address - Country:US
Mailing Address - Phone:928-724-3129
Mailing Address - Fax:
Practice Address - Street 1:TSAILE HEALTH CENTER
Practice Address - Street 2:ROUTE 64 & 12
Practice Address - City:TSAILE
Practice Address - State:AZ
Practice Address - Zip Code:86556
Practice Address - Country:US
Practice Address - Phone:928-724-3645
Practice Address - Fax:928-724-3605
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13022183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist