Provider Demographics
NPI:1083059935
Name:ALTENDORF, SEAN PATRICK (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:PATRICK
Last Name:ALTENDORF
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6027 WALNUT GROVE RD STE 110
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2115
Mailing Address - Country:US
Mailing Address - Phone:844-605-5496
Mailing Address - Fax:901-226-2496
Practice Address - Street 1:6027 WALNUT GROVE RD STE 110
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2115
Practice Address - Country:US
Practice Address - Phone:901-219-1454
Practice Address - Fax:901-226-2496
Is Sole Proprietor?:No
Enumeration Date:2013-05-06
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19376183500000X
TN40828183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist