Provider Demographics
NPI:1073926507
Name:SHARP, BONNIE (RPH)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:SHARP
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6845 DOUGLAS BLVD
Mailing Address - Street 2:
Mailing Address - City:GRANITE BAY
Mailing Address - State:CA
Mailing Address - Zip Code:95746-6258
Mailing Address - Country:US
Mailing Address - Phone:916-791-8015
Mailing Address - Fax:916-791-4476
Practice Address - Street 1:6845 DOUGLAS BLVD
Practice Address - Street 2:
Practice Address - City:GRANITE BAY
Practice Address - State:CA
Practice Address - Zip Code:95746-6258
Practice Address - Country:US
Practice Address - Phone:916-791-8015
Practice Address - Fax:916-791-4476
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37145183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist