Provider Demographics
NPI:1053692111
Name:SEBASTIAN, KENNETH CURTIS (RPH)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:CURTIS
Last Name:SEBASTIAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16675 OAK PARK AVE
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-1754
Mailing Address - Country:US
Mailing Address - Phone:708-429-0880
Mailing Address - Fax:708-429-0384
Practice Address - Street 1:16675 OAK PARK AVE
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-1754
Practice Address - Country:US
Practice Address - Phone:708-429-0880
Practice Address - Fax:708-429-0384
Is Sole Proprietor?:No
Enumeration Date:2011-09-02
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.034771183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist