Provider Demographics
NPI:1669146791
Name:PARKER, SEAN MICHAEL (PHARM D)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:MICHAEL
Last Name:PARKER
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 1:2600 WATERMARK BLVD APT 710
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-5113
Mailing Address - Country:US
Mailing Address - Phone:405-808-1115
Mailing Address - Fax:
Practice Address - Street 1:12240 N MAY AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-6806
Practice Address - Country:US
Practice Address - Phone:405-751-1938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19247183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist