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Individual

MR. SEAN BALLARD

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
RPH

Contact information

Practice address
115 N 20TH AVE, CORNELIUS, OR 97113-7471
(503) 357-0762
(503) 357-0904
Mailing address
115 N 20TH AVE, CORNELIUS, OR 97113-7471
(503) 357-0762
(503) 357-0904

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
10038
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
10038
STATE PHARMACY LICENSE
OR
Enumeration date
02/09/2012
Last updated
02/23/2023
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