Provider Demographics
NPI:1710072855
Name:SEAGROVE DRUG
Entity Type:Organization
Organization Name:SEAGROVE DRUG
Other - Org Name:CO-CARE MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LEON
Authorized Official - Middle Name:STANLEY
Authorized Official - Last Name:HAYWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:336-626-3555
Mailing Address - Street 1:900 NORTH FAYETTEVILLE STREET
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-4642
Mailing Address - Country:US
Mailing Address - Phone:336-626-3555
Mailing Address - Fax:336-625-2355
Practice Address - Street 1:900 NORTH FAYETTEVILLE STREET
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-4642
Practice Address - Country:US
Practice Address - Phone:336-626-3555
Practice Address - Fax:336-625-2355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00167332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7795155Medicaid
NC7700676Medicaid
NC7795155Medicaid