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General NPI Number Information
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NPI Number | 1295290336
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Entity Type | Individual
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Provider Name | SEAN FERNBERG PHARM D
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Gender | Male
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Dates
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Enumeration Date | 02/03/2019
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Last Update Date | 02/03/2019
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Provider Practice Location Address
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Address Line | 3370 TAMIAMI TRL
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-8127
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Country | US
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Telephone | 941-979-9085
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Fax | 941-979-8146
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Provider Business Mailing Address
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Address Line | 3370 TAMIAMI TRL
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-8127
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Country | US
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Telephone | 941-979-9085
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Fax | 941-979-8146
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS52800
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License Number State | FL
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