Provider Demographics
NPI:1023411139
Name:HASLAM, SETH WILLIAM (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SETH
Middle Name:WILLIAM
Last Name:HASLAM
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 1:39 NORTH 1ST EAST
Mailing Address - Street 2:
Mailing Address - City:PRESTON
Mailing Address - State:ID
Mailing Address - Zip Code:83263-1644
Mailing Address - Country:US
Mailing Address - Phone:208-851-1561
Mailing Address - Fax:208-852-1268
Practice Address - Street 1:39 NORTH 1ST EAST
Practice Address - Street 2:
Practice Address - City:PRESTON
Practice Address - State:ID
Practice Address - Zip Code:83263-1644
Practice Address - Country:US
Practice Address - Phone:208-851-1561
Practice Address - Fax:208-852-1268
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-02
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP6707183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist