Provider Demographics
NPI:1558907469
Name:LA FRENTZ, SEAN ALLAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:ALLAN
Last Name:LA FRENTZ
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 1:12207 W RIVER RUN DR
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77523-7551
Mailing Address - Country:US
Mailing Address - Phone:832-514-8261
Mailing Address - Fax:
Practice Address - Street 1:102 DIVISION AVE S
Practice Address - Street 2:
Practice Address - City:CAVALIER
Practice Address - State:ND
Practice Address - Zip Code:58220-4005
Practice Address - Country:US
Practice Address - Phone:701-265-4744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-26
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65716183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist