Provider Demographics
NPI:1104085372
Name:SEVAK, JIGNESH
Entity type:Individual
Prefix:
First Name:JIGNESH
Middle Name:
Last Name:SEVAK
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 1:4406 FREESTONE LN
Mailing Address - Street 2:APT 201
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-5588
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6 CARROLL ISLAND RD
Practice Address - Street 2:RITE AID PHARMACY
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21220-2206
Practice Address - Country:US
Practice Address - Phone:410-335-2323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17239183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist