Provider Demographics
NPI:1316549421
Name:ALT-SQUIRES, SHARON SUE
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:SUE
Last Name:ALT-SQUIRES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 S PLEASANT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-4400
Mailing Address - Country:US
Mailing Address - Phone:540-665-1817
Mailing Address - Fax:
Practice Address - Street 1:1950 S PLEASANT VALLEY RD
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-4400
Practice Address - Country:US
Practice Address - Phone:540-665-1817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02007931183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist