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NPI Code Detail

MEDICARE: TIANNA GRACE SEVACHKO

MEDICARE: TIANNA GRACE SEVACHKO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacistRP00008755NM

General Provider Information

NPI Number : 1033636030
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIANNA GRACE SEVACHKO
Provider Business Mailing Address
First Line : 2609 7TH ST
Second Line :
City : LAS VEGAS
State : NM
Zip : 87701-4863
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2609 7TH ST
Second Line :
City : LAS VEGAS
State : NM
Zip : 87701-4863
Country : US
Telephone Number : 505-425-5242
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/29/2017
Last Update Date : 08/29/2017

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Directions to “ TIANNA GRACE SEVACHKO ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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