Provider Demographics
NPI:1659756500
Name:ANDERSON, SEAN MICHAEL (PHARMD)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:MICHAEL
Last Name:ANDERSON
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 1:2100 GATEWAY CENTRE BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-6228
Mailing Address - Country:US
Mailing Address - Phone:919-460-3967
Mailing Address - Fax:919-460-8071
Practice Address - Street 1:2100 GATEWAY CENTRE BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-6228
Practice Address - Country:US
Practice Address - Phone:919-460-3967
Practice Address - Fax:919-460-8071
Is Sole Proprietor?:No
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25315183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist