Provider Demographics
NPI:1205289022
Name:SEVAK, RAJKUMAR (PHD, RPH)
Entity type:Individual
Prefix:DR
First Name:RAJKUMAR
Middle Name:
Last Name:SEVAK
Suffix:
Gender:M
Credentials:PHD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4616 S DEER TRL
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303-6184
Mailing Address - Country:US
Mailing Address - Phone:210-386-6112
Mailing Address - Fax:
Practice Address - Street 1:4315 GOLF CLUB DR
Practice Address - Street 2:APT 2106
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-5836
Practice Address - Country:US
Practice Address - Phone:210-386-6112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-16
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS022883183500000X
TN38529183500000X
MI5302041826183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist