Provider Demographics
NPI:1295036820
Name:NELSON, SHARON MARIE (RPH)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:MARIE
Last Name:NELSON
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 1:23961 NE STATE ROUTE 3
Mailing Address - Street 2:
Mailing Address - City:BELFAIR
Mailing Address - State:WA
Mailing Address - Zip Code:98528-9698
Mailing Address - Country:US
Mailing Address - Phone:360-275-0953
Mailing Address - Fax:360-275-0999
Practice Address - Street 1:23961 NE STATE ROUTE 3
Practice Address - Street 2:
Practice Address - City:BELFAIR
Practice Address - State:WA
Practice Address - Zip Code:98528-9698
Practice Address - Country:US
Practice Address - Phone:360-275-0953
Practice Address - Fax:360-275-0999
Is Sole Proprietor?:No
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00013734183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist