Provider Demographics
NPI:1134390172
Name:SEELEY SWAN PHARMACY INC
Entity type:Organization
Organization Name:SEELEY SWAN PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOVE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:406-677-8989
Mailing Address - Street 1:PO BOX 930
Mailing Address - Street 2:
Mailing Address - City:SEELEY LAKE
Mailing Address - State:MT
Mailing Address - Zip Code:59868-0930
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:406-677-8080
Practice Address - Street 1:3027 MT HIGHWAY 83 N
Practice Address - Street 2:LAZY PINE MALL STE J
Practice Address - City:SEELEY LAKE
Practice Address - State:MT
Practice Address - Zip Code:59868-8628
Practice Address - Country:US
Practice Address - Phone:406-677-8989
Practice Address - Fax:406-677-8080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MT12513336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2052662OtherPK
2052662OtherPK