Provider Demographics
NPI:1881222859
Name:ROBERTS, SEAN BROOKS (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:BROOKS
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42173 W LUCERA LN
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-3859
Mailing Address - Country:US
Mailing Address - Phone:623-694-7810
Mailing Address - Fax:
Practice Address - Street 1:1514 E FLORENCE BLVD
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-4741
Practice Address - Country:US
Practice Address - Phone:520-836-2787
Practice Address - Fax:520-836-0372
Is Sole Proprietor?:No
Enumeration Date:2020-03-27
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS024444183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZS024444OtherARIZONA BOARD OF PHARMACY