Provider Demographics
NPI:1508113697
Name:JEWELL, SEAN MICHAEL (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:MICHAEL
Last Name:JEWELL
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5786 MAYBERRY CT
Mailing Address - Street 2:
Mailing Address - City:OREANA
Mailing Address - State:IL
Mailing Address - Zip Code:62554-8023
Mailing Address - Country:US
Mailing Address - Phone:217-855-9342
Mailing Address - Fax:
Practice Address - Street 1:1155 E PERSHING RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-4726
Practice Address - Country:US
Practice Address - Phone:217-877-2374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.295913183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist