Provider Demographics
NPI:1861791089
Name:SELLERS, ALVA BROUGHTON JR (RPH)
Entity type:Individual
Prefix:MR
First Name:ALVA
Middle Name:BROUGHTON
Last Name:SELLERS
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 COOK RD
Mailing Address - Street 2:
Mailing Address - City:ELON
Mailing Address - State:NC
Mailing Address - Zip Code:27244-9355
Mailing Address - Country:US
Mailing Address - Phone:336-432-9570
Mailing Address - Fax:336-222-1998
Practice Address - Street 1:2344 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-5332
Practice Address - Country:US
Practice Address - Phone:336-227-7442
Practice Address - Fax:336-222-1998
Is Sole Proprietor?:No
Enumeration Date:2011-03-28
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4980183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist