Provider Demographics
NPI:1982941118
Name:KLICKER, SEAN H (PHARM D)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:H
Last Name:KLICKER
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12620 BEACH BLVD
Mailing Address - Street 2:SUITE 12
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-7131
Mailing Address - Country:US
Mailing Address - Phone:904-564-3580
Mailing Address - Fax:904-564-4643
Practice Address - Street 1:12620 BEACH BLVD
Practice Address - Street 2:SUITE 12
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-7131
Practice Address - Country:US
Practice Address - Phone:904-564-3580
Practice Address - Fax:904-564-4643
Is Sole Proprietor?:No
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS33502183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist