Provider Demographics
NPI:1043588163
Name:SEWDARSEN, ASHWIN
Entity Type:Individual
Prefix:
First Name:ASHWIN
Middle Name:
Last Name:SEWDARSEN
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 1:37893 SWEET MAGNOLIA WAY
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-6799
Mailing Address - Country:US
Mailing Address - Phone:951-252-7664
Mailing Address - Fax:
Practice Address - Street 1:37893 SWEET MAGNOLIA WAY
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-6799
Practice Address - Country:US
Practice Address - Phone:951-252-7664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-03
Last Update Date:2011-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51851183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist