Provider Demographics
NPI:1518693977
Name:SEALEY, CARTER JACOB
Entity Type:Individual
Prefix:
First Name:CARTER
Middle Name:JACOB
Last Name:SEALEY
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 1:6534 SISK CULBRETH RD
Mailing Address - Street 2:
Mailing Address - City:GODWIN
Mailing Address - State:NC
Mailing Address - Zip Code:28344-8988
Mailing Address - Country:US
Mailing Address - Phone:910-322-0696
Mailing Address - Fax:
Practice Address - Street 1:1550 SKIBO RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-3294
Practice Address - Country:US
Practice Address - Phone:910-868-5242
Practice Address - Fax:910-868-7087
Is Sole Proprietor?:No
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31455183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist