Provider Demographics
NPI:1376132696
Name:SEWARD, JOSH B
Entity Type:Individual
Prefix:
First Name:JOSH
Middle Name:B
Last Name:SEWARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 N MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:PINE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:31822-2454
Mailing Address - Country:US
Mailing Address - Phone:706-663-2255
Mailing Address - Fax:
Practice Address - Street 1:145 N MAIN AVE
Practice Address - Street 2:
Practice Address - City:PINE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:31822-2454
Practice Address - Country:US
Practice Address - Phone:706-663-2255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH021005183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist