Provider Demographics
NPI:1407161078
Name:SCHMIDT, SEAN LARSON (PHARMD, MS,)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:LARSON
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:PHARMD, MS,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1223 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-2813
Mailing Address - Country:US
Mailing Address - Phone:830-249-9565
Mailing Address - Fax:
Practice Address - Street 1:1223 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-2813
Practice Address - Country:US
Practice Address - Phone:830-249-9565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-08
Last Update Date:2010-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX49088183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist