Provider Demographics
NPI:1770037087
Name:SEAY, NATHAN RYAN
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:RYAN
Last Name:SEAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1080 JW WILSON RD
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-7698
Mailing Address - Country:US
Mailing Address - Phone:803-242-5204
Mailing Address - Fax:
Practice Address - Street 1:716 BRAGG DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-0914
Practice Address - Country:US
Practice Address - Phone:910-313-2205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-04
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36607183500000X
NC26256183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist