Provider Demographics
NPI:1972038180
Name:NEBERGALL, SEAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:
Last Name:NEBERGALL
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 1:500 W 12TH AVE.
Mailing Address - Street 2:PARKS HALL 242
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43210-1214
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 W 12TH AVE.
Practice Address - Street 2:PARKS HALL 242
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1214
Practice Address - Country:US
Practice Address - Phone:614-688-2359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-25
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03233222183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH03233222OtherSTATE LICENSE NUMBER