Healthcare Provider Details

I. General information

NPI: 1992913206
Provider Name (Legal Business Name): CYNTHIA WANDA SEWAK PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4814 E 2ND ST
LONG BEACH CA
90803-5312
US

IV. Provider business mailing address

4814 E 2ND ST
LONG BEACH CA
90803-5312
US

V. Phone/Fax

Practice location:
  • Phone: 562-439-4449
  • Fax: 562-439-4419
Mailing address:
  • Phone: 562-439-4449
  • Fax: 562-439-4419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH41090
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: