Provider Demographics
NPI:1427403922
Name:SHARP, BRUCE WALDEN (RPH)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:WALDEN
Last Name:SHARP
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 1:2611 E THOMPSON BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-2743
Mailing Address - Country:US
Mailing Address - Phone:805-648-2724
Mailing Address - Fax:805-648-7562
Practice Address - Street 1:2611 E THOMPSON BLVD STE 103
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2743
Practice Address - Country:US
Practice Address - Phone:805-648-2724
Practice Address - Fax:805-648-7562
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-03
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA271001835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist