Provider Demographics
NPI:1790391357
Name:SEBASTIAN, JAMESON KYLE (PHARM-D)
Entity type:Individual
Prefix:
First Name:JAMESON
Middle Name:KYLE
Last Name:SEBASTIAN
Suffix:
Gender:M
Credentials:PHARM-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25702-1407
Mailing Address - Country:US
Mailing Address - Phone:304-697-0366
Mailing Address - Fax:
Practice Address - Street 1:2901 5TH AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25702-1407
Practice Address - Country:US
Practice Address - Phone:304-697-0366
Practice Address - Fax:304-697-1905
Is Sole Proprietor?:No
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY021335183500000X
WV0012154183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist