Provider Demographics
NPI:1982877031
Name:ARCOT JAISHANKERVEL, SATHISH (MS,RPH)
Entity Type:Individual
Prefix:MR
First Name:SATHISH
Middle Name:
Last Name:ARCOT JAISHANKERVEL
Suffix:
Gender:M
Credentials:MS,RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 HAMMOND BRANCH RD APT 202
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-2480
Mailing Address - Country:US
Mailing Address - Phone:443-370-3954
Mailing Address - Fax:
Practice Address - Street 1:3400 MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-2021
Practice Address - Country:US
Practice Address - Phone:410-360-1509
Practice Address - Fax:410-360-4209
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18432183500000X
VA0202208271183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist