Provider Demographics
NPI:1043559180
Name:MICHAEL, SHARON R (RPH)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:R
Last Name:MICHAEL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:R
Other - Last Name:PROVOST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:112 JASON DR
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-5315
Mailing Address - Country:US
Mailing Address - Phone:318-805-2968
Mailing Address - Fax:
Practice Address - Street 1:112 JASON DR
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-5315
Practice Address - Country:US
Practice Address - Phone:318-805-2968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-09
Last Update Date:2013-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA17155183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist