Provider Demographics
NPI:1457525818
Name:SEAWAY PHARMACY , P.C.
Entity type:Organization
Organization Name:SEAWAY PHARMACY , P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RAAD
Authorized Official - Middle Name:
Authorized Official - Last Name:KOUZA
Authorized Official - Suffix:
Authorized Official - Credentials:R PH
Authorized Official - Phone:734-323-1120
Mailing Address - Street 1:8750 TELEGRAPH RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-2397
Mailing Address - Country:US
Mailing Address - Phone:313-291-2182
Mailing Address - Fax:313-291-2197
Practice Address - Street 1:8750 TELEGRAPH RD
Practice Address - Street 2:SUITE 104
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-2397
Practice Address - Country:US
Practice Address - Phone:313-291-2182
Practice Address - Fax:313-291-2197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53150349323336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy