Provider Demographics
NPI:1568628873
Name:TINGUM, SEAN R (PHARMD)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:R
Last Name:TINGUM
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 1:49725 COUNTY RD 83
Mailing Address - Street 2:LAKEWOOD HEALTH SYSTEM
Mailing Address - City:STAPLES
Mailing Address - State:MN
Mailing Address - Zip Code:56479
Mailing Address - Country:US
Mailing Address - Phone:218-894-8455
Mailing Address - Fax:218-894-8451
Practice Address - Street 1:49725 COUNTY RD 83
Practice Address - Street 2:LAKEWOOD HEALTH SYSTEM
Practice Address - City:STAPLES
Practice Address - State:MN
Practice Address - Zip Code:56479
Practice Address - Country:US
Practice Address - Phone:218-894-8455
Practice Address - Fax:218-894-8451
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN119342183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist