Provider Demographics
NPI:1447523238
Name:BALLARD, SEAN (RPH)
Entity type:Individual
Prefix:MR
First Name:SEAN
Middle Name:
Last Name:BALLARD
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 1:115 N 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:OR
Mailing Address - Zip Code:97113-7471
Mailing Address - Country:US
Mailing Address - Phone:503-357-0762
Mailing Address - Fax:503-357-0904
Practice Address - Street 1:115 N 20TH AVE
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:OR
Practice Address - Zip Code:97113-7471
Practice Address - Country:US
Practice Address - Phone:503-357-0762
Practice Address - Fax:503-357-0904
Is Sole Proprietor?:No
Enumeration Date:2012-02-09
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10038183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR10038OtherSTATE PHARMACY LICENSE