Provider Demographics
NPI:1295290336
Name:FERNBERG, SEAN (PHARM D)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:FERNBERG
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3370 TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-8127
Mailing Address - Country:US
Mailing Address - Phone:941-979-9085
Mailing Address - Fax:941-979-8146
Practice Address - Street 1:3370 TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-8127
Practice Address - Country:US
Practice Address - Phone:941-979-9085
Practice Address - Fax:941-979-8146
Is Sole Proprietor?:No
Enumeration Date:2019-02-03
Last Update Date:2019-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS52800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist