Provider Demographics
NPI:1467867408
Name:BAE, SEAN
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:BAE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 HARLEY CT
Mailing Address - Street 2:
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454-1613
Mailing Address - Country:US
Mailing Address - Phone:213-379-0365
Mailing Address - Fax:
Practice Address - Street 1:2545 ARAMINGO AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19125-3728
Practice Address - Country:US
Practice Address - Phone:215-423-2361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-28
Last Update Date:2014-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP446032183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist