Provider Demographics
NPI:1215263405
Name:SEPULVEDA, JOHN E (PHARMD)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:E
Last Name:SEPULVEDA
Suffix:
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 1:836 ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-2619
Mailing Address - Country:US
Mailing Address - Phone:619-435-6585
Mailing Address - Fax:619-435-5914
Practice Address - Street 1:836 ORANGE AVE
Practice Address - Street 2:
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118-2619
Practice Address - Country:US
Practice Address - Phone:619-435-6585
Practice Address - Fax:619-435-5914
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-23
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50512183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist