Provider Demographics
NPI:1679061709
Name:HOOS, SEAN RICHARD (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:RICHARD
Last Name:HOOS
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 1:2200 RANDALLIA DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-4699
Mailing Address - Country:US
Mailing Address - Phone:260-373-3400
Mailing Address - Fax:260-373-3418
Practice Address - Street 1:2200 RANDALLIA DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-4699
Practice Address - Country:US
Practice Address - Phone:260-373-3400
Practice Address - Fax:260-373-3418
Is Sole Proprietor?:No
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ININD-9044811835P1200X
IN26023251A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy