Provider Demographics
NPI:1851014724
Name:KEPNIA, SEDRICK
Entity Type:Individual
Prefix:
First Name:SEDRICK
Middle Name:
Last Name:KEPNIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3595 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-4615
Mailing Address - Country:US
Mailing Address - Phone:409-835-1788
Mailing Address - Fax:409-832-3129
Practice Address - Street 1:3595 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4615
Practice Address - Country:US
Practice Address - Phone:409-835-1788
Practice Address - Fax:409-832-3129
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68095183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty