Provider Demographics
NPI:1912290685
Name:SEALE HARRIS CLINIC PA
Entity Type:Organization
Organization Name:SEALE HARRIS CLINIC PA
Other - Org Name:SEALE HARRIS CLINIC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONSULTANT PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-769-3779
Mailing Address - Street 1:805 SAINT VINCENTS DR
Mailing Address - Street 2:SUITE 520
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1636
Mailing Address - Country:US
Mailing Address - Phone:205-769-3770
Mailing Address - Fax:205-745-4505
Practice Address - Street 1:805 SAINT VINCENTS DR STE 520
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1636
Practice Address - Country:US
Practice Address - Phone:205-769-3770
Practice Address - Fax:205-745-4505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-27
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1137223336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0137150OtherNCPDP PROVIDER IDENTIFICATION NUMBER