Provider Demographics
NPI:1952901514
Name:SEPEHRI, SASAN
Entity Type:Individual
Prefix:
First Name:SASAN
Middle Name:
Last Name:SEPEHRI
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 1:6973 DEEP CUP
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-4613
Mailing Address - Country:US
Mailing Address - Phone:443-477-3439
Mailing Address - Fax:
Practice Address - Street 1:7200 CRADLEROCK WAY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-5170
Practice Address - Country:US
Practice Address - Phone:410-290-7013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-31
Last Update Date:2020-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24838183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist