Provider Demographics
NPI:1407139678
Name:THAKKAR, SEJAL K (PHARMD)
Entity Type:Individual
Prefix:
First Name:SEJAL
Middle Name:K
Last Name:THAKKAR
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 HOLABIRD AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-6015
Mailing Address - Country:US
Mailing Address - Phone:410-288-8947
Mailing Address - Fax:410-288-8454
Practice Address - Street 1:5901 HOLABIRD AVE, SUITE A
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224
Practice Address - Country:US
Practice Address - Phone:410-288-8947
Practice Address - Fax:410-282-8454
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202208536183500000X
MD195201835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist