Provider Demographics
NPI:1760495089
Name:SOUTHEAST INC
Entity Type:Organization
Organization Name:SOUTHEAST INC
Other - Org Name:APOTHECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIR OF PHRMCY
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WISSINGER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:614-228-4476
Mailing Address - Street 1:131 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-3018
Mailing Address - Country:US
Mailing Address - Phone:614-228-4476
Mailing Address - Fax:614-228-4479
Practice Address - Street 1:131 N HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-3018
Practice Address - Country:US
Practice Address - Phone:614-228-4476
Practice Address - Fax:614-228-4479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336S0011X
OH0212806503336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2078405OtherPK
OH2262546Medicaid
WV6040078000Medicaid