Provider Demographics
NPI:1639491731
Name:DAVE, SEJAL A (RPH)
Entity Type:Individual
Prefix:
First Name:SEJAL
Middle Name:A
Last Name:DAVE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 FINCHER ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112-5113
Mailing Address - Country:US
Mailing Address - Phone:704-225-9010
Mailing Address - Fax:704-225-7179
Practice Address - Street 1:500 FINCHER ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5113
Practice Address - Country:US
Practice Address - Phone:704-225-9010
Practice Address - Fax:704-225-7179
Is Sole Proprietor?:No
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17413183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0282937160Medicare PIN