Provider Demographics
NPI:1003196312
Name:ALCORN, SHARON ANN
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:ANN
Last Name:ALCORN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38086 SUMMERWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-4283
Mailing Address - Country:US
Mailing Address - Phone:504-473-4723
Mailing Address - Fax:
Practice Address - Street 1:4485 PERKINS RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-3034
Practice Address - Country:US
Practice Address - Phone:225-926-0734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-18
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA018389183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist