Provider Demographics
NPI:1154449023
Name:SHARPE, FRED FIELDING (RPH)
Entity Type:Individual
Prefix:MR
First Name:FRED
Middle Name:FIELDING
Last Name:SHARPE
Suffix:
Gender:M
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:PO BOX 542
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31702-0542
Mailing Address - Country:US
Mailing Address - Phone:229-435-4571
Mailing Address - Fax:229-878-4926
Practice Address - Street 1:1579 US HWY 19 SOUTH
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:GA
Practice Address - Zip Code:31763-0542
Practice Address - Country:US
Practice Address - Phone:229-435-4571
Practice Address - Fax:229-878-4926
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA011229183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist