Provider Demographics
NPI:1467719625
Name:BURLESON, SEAN GREGORY (RPH)
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:GREGORY
Last Name:BURLESON
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 1:6901 S 19TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98466-5529
Mailing Address - Country:US
Mailing Address - Phone:253-534-3033
Mailing Address - Fax:253-534-3027
Practice Address - Street 1:6901 S 19TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98466-5529
Practice Address - Country:US
Practice Address - Phone:253-534-3033
Practice Address - Fax:253-534-3027
Is Sole Proprietor?:No
Enumeration Date:2012-04-12
Last Update Date:2020-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60133346183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist