Provider Demographics
NPI:1568790855
Name:SEAL, RUSSELL DEAN (RPH)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:DEAN
Last Name:SEAL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7103 MARBACH RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78227-1913
Mailing Address - Country:US
Mailing Address - Phone:210-675-6611
Mailing Address - Fax:210-674-6441
Practice Address - Street 1:7103 MARBACH RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78227-1913
Practice Address - Country:US
Practice Address - Phone:210-675-6611
Practice Address - Fax:210-674-6441
Is Sole Proprietor?:No
Enumeration Date:2009-11-24
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26471183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist