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Organization
SEASIDE PHARMACEUTICAL INC
Active
Organization
SEASIDE PHARMACEUTICAL INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT STANLEY TRETHAWAY PHARMACIST (OWNER/CEO)
(912) 554-8220
Entity
Organization
Contact information
Practice address
1104 FOUNTAIN PARK CIRCLE, BRUNSWICK, GA 31520-4758
(912) 554-8220
(912) 554-8221
Mailing address
1104 FOUNTAIN PARK CIRCLE, BRUNSWICK, GA 31520-4758
(912) 554-8220
(912) 554-8221
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH020213
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11639
OCCUPATIONAL TAX LICENSE
GA
05
—
407152969A
—
GA
01
—
PHHH000002
PHARMACY LICENSE
GA
Enumeration date
05/28/2006
Last updated
03/07/2023
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