Provider Demographics
NPI:1477646248
Name:BRAY & SEAGO INC
Entity Type:Organization
Organization Name:BRAY & SEAGO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUPERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GREELING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-498-4513
Mailing Address - Street 1:114 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:JERSEYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62052-1701
Mailing Address - Country:US
Mailing Address - Phone:618-498-4513
Mailing Address - Fax:618-498-5771
Practice Address - Street 1:114 N STATE ST
Practice Address - Street 2:
Practice Address - City:JERSEYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62052-1701
Practice Address - Country:US
Practice Address - Phone:618-498-4513
Practice Address - Fax:618-498-5771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========01Medicaid