Provider Demographics
NPI:1669003208
Name:SESHAN, USHA L
Entity Type:Individual
Prefix:
First Name:USHA
Middle Name:L
Last Name:SESHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-2846
Mailing Address - Country:US
Mailing Address - Phone:248-548-5057
Mailing Address - Fax:248-414-5751
Practice Address - Street 1:525 E 4TH ST
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-2846
Practice Address - Country:US
Practice Address - Phone:248-548-5057
Practice Address - Fax:248-414-5751
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302033128183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist