Provider Demographics
NPI:1710117643
Name:SEASHOLTZ, DORIS ELLA
Entity Type:Individual
Prefix:MRS
First Name:DORIS
Middle Name:ELLA
Last Name:SEASHOLTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:DORIS
Other - Middle Name:ELLA
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:99 GEORGE LN
Mailing Address - Street 2:
Mailing Address - City:SELINSGROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17870-8110
Mailing Address - Country:US
Mailing Address - Phone:570-884-9600
Mailing Address - Fax:
Practice Address - Street 1:ROUTE 11
Practice Address - Street 2:SYNERGY GRANDVIEW PHARMACY INC
Practice Address - City:NORTHUMBERLAND
Practice Address - State:PA
Practice Address - Zip Code:17857
Practice Address - Country:US
Practice Address - Phone:570-473-7506
Practice Address - Fax:570-473-9336
Is Sole Proprietor?:No
Enumeration Date:2009-07-27
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP038166L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist