Provider Demographics
NPI:1962656785
Name:FITZPATRICK, SEAN MALONE (RPH; PHARMD)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:MALONE
Last Name:FITZPATRICK
Suffix:
Gender:M
Credentials:RPH; PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 MAIN AVE N
Mailing Address - Street 2:
Mailing Address - City:TILLAMOOK
Mailing Address - State:OR
Mailing Address - Zip Code:97141-7784
Mailing Address - Country:US
Mailing Address - Phone:803-815-1433
Mailing Address - Fax:503-815-1427
Practice Address - Street 1:1215 W 6TH ST
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-3515
Practice Address - Country:US
Practice Address - Phone:541-296-1748
Practice Address - Fax:541-296-1756
Is Sole Proprietor?:No
Enumeration Date:2008-11-06
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR111881835P0018X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist