Provider Demographics
NPI:1518054816
Name:SOUTHEAST PHARMACEUTICALS, INC.
Entity Type:Organization
Organization Name:SOUTHEAST PHARMACEUTICALS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:NEAL
Authorized Official - Last Name:HOLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:334-897-3746
Mailing Address - Street 1:PO BOX 415
Mailing Address - Street 2:
Mailing Address - City:ELBA
Mailing Address - State:AL
Mailing Address - Zip Code:36323-0415
Mailing Address - Country:US
Mailing Address - Phone:334-897-3746
Mailing Address - Fax:334-897-3716
Practice Address - Street 1:704 TROY HWY
Practice Address - Street 2:STE A
Practice Address - City:ELBA
Practice Address - State:AL
Practice Address - Zip Code:36323-1521
Practice Address - Country:US
Practice Address - Phone:334-897-3746
Practice Address - Fax:334-897-3716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL027146332B00000X, 332BC3200X, 332BP3500X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106273501Medicaid
AL009505350Medicaid
AL510-36152OtherBCBS
AL=========001OtherTRICARE
AL009505350Medicaid
AL=========OtherMAILHANDLERS
AL=========OtherUNITED HEALTHCARE
AL0942780001Medicare NSC