Provider Demographics
NPI:1619314119
Name:JARIWALA, SEAN AJAY (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:AJAY
Last Name:JARIWALA
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 1:2100 CARLISLE BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-3810
Mailing Address - Country:US
Mailing Address - Phone:505-265-3549
Mailing Address - Fax:505-256-0179
Practice Address - Street 1:2100 CARLISLE BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-3810
Practice Address - Country:US
Practice Address - Phone:505-265-3549
Practice Address - Fax:505-256-0179
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00007833183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist