Provider Demographics
NPI:1578163044
Name:SEBASTIAN, MADISON KAYE (PHARM D)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:KAYE
Last Name:SEBASTIAN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 RUE CHARLEMAGNE
Mailing Address - Street 2:
Mailing Address - City:BONNE TERRE
Mailing Address - State:MO
Mailing Address - Zip Code:63628-9254
Mailing Address - Country:US
Mailing Address - Phone:573-366-0131
Mailing Address - Fax:
Practice Address - Street 1:1101 W HIGHWAY 32
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MO
Practice Address - Zip Code:65560-2368
Practice Address - Country:US
Practice Address - Phone:573-729-4131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017026040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist