Provider Demographics
NPI:1487649240
Name:SEASIDE PRESCRIPTION PHARMACY INC
Entity type:Organization
Organization Name:SEASIDE PRESCRIPTION PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:R
Authorized Official - Last Name:SEIBERT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:310-833-3551
Mailing Address - Street 1:599 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-3115
Mailing Address - Country:US
Mailing Address - Phone:310-833-3551
Mailing Address - Fax:310-833-3552
Practice Address - Street 1:599 W 7TH ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-3115
Practice Address - Country:US
Practice Address - Phone:310-833-3551
Practice Address - Fax:310-833-3552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY43976333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY43976OtherPHARMACY LIC #
CAPHA439760Medicaid
CAPHA439760Medicaid
CA5325220001Medicare NSC