Provider Demographics
NPI:1194154757
Name:SEAL, JAMES
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:SEAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4430 EMERALD GARDEN RD
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-8269
Mailing Address - Country:US
Mailing Address - Phone:870-598-4147
Mailing Address - Fax:
Practice Address - Street 1:601 N SAINT JOSEPH ST
Practice Address - Street 2:
Practice Address - City:MORRILTON
Practice Address - State:AR
Practice Address - Zip Code:72110-2104
Practice Address - Country:US
Practice Address - Phone:501-354-4669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD05881183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist