Provider Demographics
NPI:1205158425
Name:SEVAK, ASHISH R (R,PH)
Entity type:Individual
Prefix:
First Name:ASHISH
Middle Name:R
Last Name:SEVAK
Suffix:
Gender:M
Credentials:R,PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W 231ST ST # C
Mailing Address - Street 2:KINGSBRIDGE PHARMACY
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-5359
Mailing Address - Country:US
Mailing Address - Phone:718-432-2240
Mailing Address - Fax:
Practice Address - Street 1:200 W 231ST ST # C
Practice Address - Street 2:KINGSBRIDGE PHARMACY
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-5359
Practice Address - Country:US
Practice Address - Phone:718-432-2240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-16
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045256183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist