Provider Demographics
NPI:1932560653
Name:SACHITANO, DEREK ALEXANDER (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:ALEXANDER
Last Name:SACHITANO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6380 FOLSOM DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-7265
Mailing Address - Country:US
Mailing Address - Phone:180-088-0990
Mailing Address - Fax:
Practice Address - Street 1:6380 FOLSOM DR
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-7265
Practice Address - Country:US
Practice Address - Phone:180-088-0990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX488801835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX48880OtherTSBP