Provider Demographics
NPI:1699090720
Name:SEWELL, HENRY J JR
Entity type:Individual
Prefix:MR
First Name:HENRY
Middle Name:J
Last Name:SEWELL
Suffix:JR
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 1:208 GLEN EAGLES DR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-6920
Mailing Address - Country:US
Mailing Address - Phone:334-794-4580
Mailing Address - Fax:
Practice Address - Street 1:1909 HONEYSUCKLE RD
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-4289
Practice Address - Country:US
Practice Address - Phone:334-836-0890
Practice Address - Fax:334-836-0894
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-31
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK7200OtherSTATE OF ALABAMA LICENSE