Provider Demographics
NPI:1235129529
Name:CLACKUM, SHARON F (PHARMD, CGP, FASCP)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:F
Last Name:CLACKUM
Suffix:
Gender:F
Credentials:PHARMD, CGP, FASCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3513 HABERSHAM CLUB DR
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-8002
Mailing Address - Country:US
Mailing Address - Phone:770-329-8794
Mailing Address - Fax:770-428-0278
Practice Address - Street 1:3513 HABERSHAM CLUB DR
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-8002
Practice Address - Country:US
Practice Address - Phone:770-329-8794
Practice Address - Fax:770-428-0278
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA13176183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist