Provider Demographics
NPI:1043758113
Name:POWERS, SHARLENE
Entity Type:Individual
Prefix:
First Name:SHARLENE
Middle Name:
Last Name:POWERS
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 1:1709 DAVINCI DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-6836
Mailing Address - Country:US
Mailing Address - Phone:636-699-8082
Mailing Address - Fax:636-265-1306
Practice Address - Street 1:7776 WINGHAVEN BLVD
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-3601
Practice Address - Country:US
Practice Address - Phone:636-265-2924
Practice Address - Fax:636-265-1306
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO043673183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist