Provider Demographics
NPI:1558872036
Name:NUTTER, SEAN ELLIOTT (PHARM D)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:ELLIOTT
Last Name:NUTTER
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 1:20 E PITTSTON RD
Mailing Address - Street 2:
Mailing Address - City:PITTSTON
Mailing Address - State:ME
Mailing Address - Zip Code:04345-5174
Mailing Address - Country:US
Mailing Address - Phone:802-477-2954
Mailing Address - Fax:
Practice Address - Street 1:150 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-7241
Practice Address - Country:US
Practice Address - Phone:207-626-0364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-24
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR46882183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist