Healthcare Provider Details

I. General information

NPI: 1215851829
Provider Name (Legal Business Name): SEAN HAUCK PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

995 LOGANVILLE HWY
BETHLEHEM GA
30620
US

IV. Provider business mailing address

238 HIGHLAND LAKE CIR
DECATUR GA
30033-3442
US

V. Phone/Fax

Practice location:
  • Phone: 470-900-2960
  • Fax:
Mailing address:
  • Phone: 470-819-6975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH036353
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: