Provider Demographics
NPI:1245579473
Name:SHARPE, ROOSEVELT JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROOSEVELT
Middle Name:
Last Name:SHARPE
Suffix:JR
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 1:11406 CLASSICAL LN
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-5023
Mailing Address - Country:US
Mailing Address - Phone:301-467-3747
Mailing Address - Fax:301-576-5319
Practice Address - Street 1:11406 CLASSICAL LN
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-5023
Practice Address - Country:US
Practice Address - Phone:301-681-9217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPHA23075183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist