Provider Demographics
NPI:1477881498
Name:REVELL, SEAN M (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:M
Last Name:REVELL
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 1:3601 ANDREWS HWY APT 803
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79703-4956
Mailing Address - Country:US
Mailing Address - Phone:806-206-7270
Mailing Address - Fax:
Practice Address - Street 1:1305 W UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79764-7121
Practice Address - Country:US
Practice Address - Phone:432-580-0166
Practice Address - Fax:432-337-1326
Is Sole Proprietor?:No
Enumeration Date:2009-12-02
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX47522183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist