Provider Demographics
NPI:1922407592
Name:OOTTAMAKORN, SEAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:OOTTAMAKORN
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 1:19711 E SMOKY HILL RD
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80015-5194
Mailing Address - Country:US
Mailing Address - Phone:303-400-5204
Mailing Address - Fax:
Practice Address - Street 1:19711 E SMOKY HILL RD
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80015-5194
Practice Address - Country:US
Practice Address - Phone:303-400-5204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20346183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist