Provider Demographics
NPI:1790144343
Name:NIGEDA, SENAYET (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SENAYET
Middle Name:
Last Name:NIGEDA
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 1:1530 W HIGHWAY 50
Mailing Address - Street 2:PHARMACY
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-1619
Mailing Address - Country:US
Mailing Address - Phone:618-632-9381
Mailing Address - Fax:
Practice Address - Street 1:1530 W HIGHWAY 50
Practice Address - Street 2:PHARMACY
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1619
Practice Address - Country:US
Practice Address - Phone:618-632-9381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051299292183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist