Provider Demographics
NPI:1225633662
Name:KIDWELL, SEAN PATRICK (PHARMD)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:PATRICK
Last Name:KIDWELL
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 1:383 WILSON STREET
Mailing Address - Street 2:PHARMACY DEPARTMENT
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412
Mailing Address - Country:US
Mailing Address - Phone:207-989-8290
Mailing Address - Fax:207-989-8293
Practice Address - Street 1:383 WILSON STREET
Practice Address - Street 2:PHARMACY DEPARTMENT
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412
Practice Address - Country:US
Practice Address - Phone:207-989-8290
Practice Address - Fax:207-989-8293
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR5758183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist