Provider Demographics
NPI:1538460639
Name:SHARENBROCK, KERMIT (BS)
Entity Type:Individual
Prefix:MR
First Name:KERMIT
Middle Name:
Last Name:SHARENBROCK
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2035 N CARSON ST
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-2248
Mailing Address - Country:US
Mailing Address - Phone:775-882-2110
Mailing Address - Fax:775-882-6287
Practice Address - Street 1:2035 N CARSON ST
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-2248
Practice Address - Country:US
Practice Address - Phone:775-882-2110
Practice Address - Fax:775-882-6287
Is Sole Proprietor?:No
Enumeration Date:2010-11-05
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5245183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist