Provider Demographics
NPI:1639820509
Name:SEELEY, SALLY REBECCA (PHARMD, BC-ADM)
Entity Type:Individual
Prefix:DR
First Name:SALLY
Middle Name:REBECCA
Last Name:SEELEY
Suffix:
Gender:F
Credentials:PHARMD, BC-ADM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7620 THORNAPPLE RIVER DR SE
Mailing Address - Street 2:
Mailing Address - City:CALEDONIA
Mailing Address - State:MI
Mailing Address - Zip Code:49316-9522
Mailing Address - Country:US
Mailing Address - Phone:616-710-2388
Mailing Address - Fax:
Practice Address - Street 1:221 MICHIGAN ST NE STE 200
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2533
Practice Address - Country:US
Practice Address - Phone:616-267-8950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-12
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53024117181835P0018X, 208U00000X, 1835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory CareGroup - Single Specialty
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Single Specialty
No208U00000XAllopathic & Osteopathic PhysiciansClinical PharmacologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI530-521-1718OtherSTATE LICENSE NUMBER