Provider Demographics
NPI:1669527669
Name:SEIBEL, LESA
Entity type:Individual
Prefix:
First Name:LESA
Middle Name:
Last Name:SEIBEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3832 HIGHWAY 414
Mailing Address - Street 2:
Mailing Address - City:LANDRUM
Mailing Address - State:SC
Mailing Address - Zip Code:29356-9505
Mailing Address - Country:US
Mailing Address - Phone:864-895-2367
Mailing Address - Fax:
Practice Address - Street 1:109 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-1921
Practice Address - Country:US
Practice Address - Phone:864-877-0753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19893183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC10-03095OtherSCDHEC BUREAU OF DRUG CON
SCBM4276805OtherDEA
SC730956Medicare ID - Type Unspecified
SC10-03095OtherSCDHEC BUREAU OF DRUG CON