MEDICARE: DR. SEAN KENNETH SHIRK PHARM D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS37118	FL

General Provider Information

NPI Number	:	1295015774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEAN KENNETH SHIRK PHARM D

Provider Business Mailing Address
First Line	:	85 E MITCHELL HAMMOCK RD
Second Line	:
City	:	OVIEDO
State	:	FL
Zip	:	32765-9780
Country	:	US
Telephone Number	:	407-977-1518
Fax Number	:	407-977-1389

Provider Business Practice Location Address
First Line	:	85 E MITCHELL HAMMOCK RD
Second Line	:
City	:	OVIEDO
State	:	FL
Zip	:	32765-9780
Country	:	US
Telephone Number	:	407-977-1518
Fax Number	:	407-977-1389

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2011
Last Update Date	:	08/28/2011

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