Provider Demographics
NPI:1700119120
Name:PHOTHIYANE, SEAN P (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:P
Last Name:PHOTHIYANE
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 1:198 NE COMBS FLAT RD STE 100
Mailing Address - Street 2:
Mailing Address - City:PRINEVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97754-2563
Mailing Address - Country:US
Mailing Address - Phone:541-447-4111
Mailing Address - Fax:541-416-9570
Practice Address - Street 1:198 NE COMBS FLAT RD STE 100
Practice Address - Street 2:
Practice Address - City:PRINEVILLE
Practice Address - State:OR
Practice Address - Zip Code:97754-2563
Practice Address - Country:US
Practice Address - Phone:541-447-4111
Practice Address - Fax:541-416-9570
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-16
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH108511835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist