Healthcare Provider Details

I. General information

NPI: 1003440751
Provider Name (Legal Business Name): JASON ALEX SEFSIK PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2020
Last Update Date: 03/02/2020
Certification Date: 03/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 HEMINGWAY AVE
EAST HAVEN CT
06512-3404
US

IV. Provider business mailing address

10 HEMINGWAY AVE
EAST HAVEN CT
06512-3404
US

V. Phone/Fax

Practice location:
  • Phone: 203-469-4609
  • Fax:
Mailing address:
  • Phone: 203-469-4609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPCT.0014586
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: