Provider Demographics
NPI:1326204413
Name:SEBASTIAN, LIGY TRESA (PHARMD)
Entity Type:Individual
Prefix:
First Name:LIGY
Middle Name:TRESA
Last Name:SEBASTIAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:LIGY
Other - Middle Name:TRESA
Other - Last Name:JOHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:7346 DARTFORD DR
Mailing Address - Street 2:APT. #1
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-7319
Mailing Address - Country:US
Mailing Address - Phone:936-526-4427
Mailing Address - Fax:
Practice Address - Street 1:5999 BURKE COMMONS RD
Practice Address - Street 2:PHARMACY CALL CENTER
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-2880
Practice Address - Country:US
Practice Address - Phone:703-249-7874
Practice Address - Fax:703-249-7850
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02022086471835P0018X
MD188681835P0018X
TX46967183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist