Provider Demographics
NPI:1902443963
Name:SESTI, JASON
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:SESTI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3095 GOODMAN RD E
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38672-8707
Mailing Address - Country:US
Mailing Address - Phone:662-536-3743
Mailing Address - Fax:662-536-3746
Practice Address - Street 1:3095 GOODMAN RD E
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38672-8707
Practice Address - Country:US
Practice Address - Phone:662-536-3743
Practice Address - Fax:662-536-3746
Is Sole Proprietor?:No
Enumeration Date:2019-12-09
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-09804183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist