Provider Demographics
NPI:1487986204
Name:SEAWARD, GARY HENRY
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:HENRY
Last Name:SEAWARD
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 1:6363 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5855
Mailing Address - Country:US
Mailing Address - Phone:716-635-5000
Mailing Address - Fax:716-635-5700
Practice Address - Street 1:299 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14904-1393
Practice Address - Country:US
Practice Address - Phone:607-734-0637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037566183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY037566OtherSTATE LICENSE NUMBER