Healthcare Provider Details

I. General information

NPI: 1558223057
Provider Name (Legal Business Name): ANGEL SEBASTIAN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1960 W MAIN ST
MESA AZ
85201-6914
US

IV. Provider business mailing address

150 S ROOSEVELT RD APT 3009
MESA AZ
85202-1083
US

V. Phone/Fax

Practice location:
  • Phone: 480-644-8873
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS027793
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: