Provider Demographics
NPI:1215094131
Name:SEBASTIANELLI, SAMUEL R JR (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:R
Last Name:SEBASTIANELLI
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 BEVERLEY RD
Mailing Address - Street 2:
Mailing Address - City:EYNON
Mailing Address - State:PA
Mailing Address - Zip Code:18403-1257
Mailing Address - Country:US
Mailing Address - Phone:570-267-4481
Mailing Address - Fax:
Practice Address - Street 1:702 N BLAKELY ST
Practice Address - Street 2:
Practice Address - City:DUNMORE
Practice Address - State:PA
Practice Address - Zip Code:18512-1963
Practice Address - Country:US
Practice Address - Phone:570-342-8427
Practice Address - Fax:570-342-9748
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP046261183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist