Provider Demographics
NPI:1477868503
Name:COURREGE, SHARON D (RPH)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:D
Last Name:COURREGE
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 1:4460 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-4312
Mailing Address - Country:US
Mailing Address - Phone:337-478-6042
Mailing Address - Fax:337-478-6708
Practice Address - Street 1:4460 LAKE ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-4312
Practice Address - Country:US
Practice Address - Phone:337-478-6042
Practice Address - Fax:337-478-6708
Is Sole Proprietor?:No
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10277183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist