Provider Demographics
NPI:1770017709
Name:CHRISTIANSEN, SEAN MICHAEL (RPH)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:MICHAEL
Last Name:CHRISTIANSEN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 S KENT ST
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99337-4124
Mailing Address - Country:US
Mailing Address - Phone:801-608-9228
Mailing Address - Fax:
Practice Address - Street 1:1308 N 20TH AVE
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-4054
Practice Address - Country:US
Practice Address - Phone:509-545-9581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-17
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60700908183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist