Provider Demographics
NPI:1093931750
Name:DEASON, SHARON B (RPH)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:B
Last Name:DEASON
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 1:13 WOODLAND TRL
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-3318
Mailing Address - Country:US
Mailing Address - Phone:770-251-2690
Mailing Address - Fax:
Practice Address - Street 1:100 GLENDA TRCE
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-3863
Practice Address - Country:US
Practice Address - Phone:770-502-8665
Practice Address - Fax:770-502-8752
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11575183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist