Provider Demographics
NPI:1093031577
Name:SEIFERT HEALTHCARE LLC
Entity type:Organization
Organization Name:SEIFERT HEALTHCARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEMENTS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:574-295-4333
Mailing Address - Street 1:PO BOX 425
Mailing Address - Street 2:
Mailing Address - City:WAKARUSA
Mailing Address - State:IN
Mailing Address - Zip Code:46573-0425
Mailing Address - Country:US
Mailing Address - Phone:574-862-1454
Mailing Address - Fax:574-862-4923
Practice Address - Street 1:100 NORTH ELKHART
Practice Address - Street 2:
Practice Address - City:WAKARUSA
Practice Address - State:IN
Practice Address - Zip Code:46573-9305
Practice Address - Country:US
Practice Address - Phone:574-862-1454
Practice Address - Fax:574-862-4923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-09
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
IN60006218A3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1562900OtherNCPDP PROVIDER IDENTIFICATION NUMBER
1562900OtherNCPDP PROVIDER IDENTIFICATION NUMBER