Provider Demographics
NPI:1679170963
Name:MCINTYRE, SETH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SETH
Middle Name:
Last Name:MCINTYRE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4125 N SHERIDAN RD STE 20
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-7174
Mailing Address - Country:US
Mailing Address - Phone:309-686-7058
Mailing Address - Fax:309-686-7119
Practice Address - Street 1:4125 N SHERIDAN RD STE 20
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-7174
Practice Address - Country:US
Practice Address - Phone:309-686-7058
Practice Address - Fax:309-686-7119
Is Sole Proprietor?:No
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.301334183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist