Healthcare Provider Details

I. General information

NPI: 1558907469
Provider Name (Legal Business Name): SEAN ALLAN LA FRENTZ PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2019
Last Update Date: 11/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 DIVISION AVE S
CAVALIER ND
58220-4005
US

IV. Provider business mailing address

12207 W RIVER RUN DR
BAYTOWN TX
77523-7551
US

V. Phone/Fax

Practice location:
  • Phone: 701-265-4744
  • Fax:
Mailing address:
  • Phone: 832-514-8261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number65716
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: