Provider Demographics
NPI:1275207573
Name:MCCREA, J SEAN MICHAEL
Entity Type:Individual
Prefix:
First Name:J SEAN
Middle Name:MICHAEL
Last Name:MCCREA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:SEAN
Other - Middle Name:MICHAEL
Other - Last Name:MCCREA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2301 S CONGRESS AVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-5253
Mailing Address - Country:US
Mailing Address - Phone:512-442-1578
Mailing Address - Fax:
Practice Address - Street 1:2301 S CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-5253
Practice Address - Country:US
Practice Address - Phone:512-442-1578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-02
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72781183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist