Provider Demographics
NPI:1003273145
Name:SHARPE, ANGELA
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:SHARPE
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:PO BOX 111
Mailing Address - Street 2:36 EAST MAIN ST
Mailing Address - City:HILDA
Mailing Address - State:SC
Mailing Address - Zip Code:29813
Mailing Address - Country:US
Mailing Address - Phone:803-541-1834
Mailing Address - Fax:
Practice Address - Street 1:2 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:SC
Practice Address - Zip Code:29853
Practice Address - Country:US
Practice Address - Phone:803-266-4345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8234183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist